Provider Demographics
NPI:1083912166
Name:DAVIS, PATRICIA DIAN
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:DIAN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4773 MADRID RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-3682
Mailing Address - Country:US
Mailing Address - Phone:702-656-9890
Mailing Address - Fax:702-656-9152
Practice Address - Street 1:4773 MADRID RIDGE CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-3682
Practice Address - Country:US
Practice Address - Phone:702-656-9890
Practice Address - Fax:702-656-9152
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation