Provider Demographics
NPI:1336467620
Name:DAVIS, TREASA L (DO)
Entity Type:Individual
Prefix:
First Name:TREASA
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:191 S BUENA VISTA ST STE 375
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4558
Mailing Address - Country:US
Mailing Address - Phone:818-729-0014
Mailing Address - Fax:818-729-0019
Practice Address - Street 1:191 S BUENA VISTA ST STE 375
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4558
Practice Address - Country:US
Practice Address - Phone:818-729-0014
Practice Address - Fax:818-729-0019
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2017-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A12858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine