Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 61920 | CA |
Y | 207X00000X | Orthopaedic Surgeon | A61920 | CA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A61920 | CA |
NPI | 1730150830 |
---|---|
Provider Name | Dr. Daniel K. Davis |
First Address | Ventura, CA 93003-7844 |
Second Address | Simi Valley, CA 93065-2352 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2006 |
Last Update Date | 27/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A61920 | STATE LICENSE (01) | CA |
H68876 | (02) | CA |
H68876 | UPIN (01) | CA |