Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC30045 | CA |
NPI | 1417139734 |
---|---|
Provider Name | Dr. William R Davis JR. |
First Address | Placentia, CA 92870-5710 |
Second Address | Placentia, CA 92870-5710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2007 |
Last Update Date | 11/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC30045 | (02) | CA |