Provider Demographics
NPI:1073583134
Name:DAVIS, CYNTHIA L (RD)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 SOUTH ALAMO AVE
Mailing Address - Street 2:
Mailing Address - City:DMAFB
Mailing Address - State:AZ
Mailing Address - Zip Code:85707-4405
Mailing Address - Country:US
Mailing Address - Phone:520-228-1003
Mailing Address - Fax:
Practice Address - Street 1:4175 SOUTH ALAMO AVE
Practice Address - Street 2:
Practice Address - City:DMAFB
Practice Address - State:AZ
Practice Address - Zip Code:85707-4405
Practice Address - Country:US
Practice Address - Phone:520-228-1003
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ85007167OtherCDR