Provider Demographics
NPI:1275680738
Name:DAVIS, TRACIE LYN (MD, FACOG)
Entity Type:Individual
Prefix:DR
First Name:TRACIE
Middle Name:LYN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD, FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8851 CENTER DR STE 210
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3045
Mailing Address - Country:US
Mailing Address - Phone:194-637-7756
Mailing Address - Fax:619-463-4181
Practice Address - Street 1:8851 CENTER DR STE 210
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3045
Practice Address - Country:US
Practice Address - Phone:619-463-7775
Practice Address - Fax:619-463-4181
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89865207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
9013016OtherAMERICAN BOARD OF OBSTETRICS & GYNECOLOGY
9013016OtherAMERICAN BOARD OF OBSTETRICS & GYNECOLOGY