Provider Demographics
NPI:1629138680
Name:DAVIS, DOLORES MARIA
Entity Type:Individual
Prefix:MRS
First Name:DOLORES
Middle Name:MARIA
Last Name:DAVIS
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 1:83 E SHAW AVE
Mailing Address - Street 2:102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7620
Mailing Address - Country:US
Mailing Address - Phone:559-226-0167
Mailing Address - Fax:559-226-1559
Practice Address - Street 1:83 E SHAW AVE
Practice Address - Street 2:102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7620
Practice Address - Country:US
Practice Address - Phone:559-226-0167
Practice Address - Fax:559-226-1559
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist