Provider Demographics
NPI:1588018113
Name:DAVIS, VIRGINIA (RD)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1220 W 24TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8705
Mailing Address - Country:US
Mailing Address - Phone:928-329-8331
Mailing Address - Fax:928-329-8528
Practice Address - Street 1:1220 W 24TH ST STE 1
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8705
Practice Address - Country:US
Practice Address - Phone:928-329-8331
Practice Address - Fax:928-329-8528
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered