Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | A95340 | CA |
NPI | 1104152628 |
---|---|
Provider Name | Dr. Tom Belle Davidson |
First Address | Los Angeles, CA 90028-7900 |
Second Address | Los Angeles, CA 90027-6062 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2009 |
Last Update Date | 19/10/2009 |