Provider Demographics
NPI:1467040436
Name:DAVONY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:DAVONY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-294-2657
Mailing Address - Street 1:7265 WINTERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-5412
Mailing Address - Country:US
Mailing Address - Phone:818-294-2657
Mailing Address - Fax:661-310-3848
Practice Address - Street 1:7265 WINTERWOOD LN
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-5412
Practice Address - Country:US
Practice Address - Phone:818-294-2657
Practice Address - Fax:661-310-3848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care