Provider Demographics
NPI:1003531534
Name:DAVIS, NICOLLETTE (LAC)
Entity Type:Individual
Prefix:
First Name:NICOLLETTE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12228 SUMMER LN
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1091
Mailing Address - Country:US
Mailing Address - Phone:661-331-7733
Mailing Address - Fax:
Practice Address - Street 1:1101 S ANAHEIM BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5811
Practice Address - Country:US
Practice Address - Phone:714-937-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist