Provider Demographics
NPI:1417698754
Name:DAVENPORT, ZENOBIA
Entity Type:Individual
Prefix:
First Name:ZENOBIA
Middle Name:
Last Name:DAVENPORT
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 1:28850 MURRIETA RD
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92586-2734
Mailing Address - Country:US
Mailing Address - Phone:951-385-0107
Mailing Address - Fax:
Practice Address - Street 1:28850 MURRIETA RD
Practice Address - Street 2:
Practice Address - City:MENIFFE
Practice Address - State:CALIFORNIA
Practice Address - Zip Code:92586
Practice Address - Country:UM
Practice Address - Phone:951-385-0107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty