Provider Demographics
NPI:1669651022
Name:DAVIS, DAVETH A (CCP)
Entity Type:Individual
Prefix:MISS
First Name:DAVETH
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 SANDPIPER CT
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-1320
Mailing Address - Country:US
Mailing Address - Phone:650-815-8632
Mailing Address - Fax:650-615-9995
Practice Address - Street 1:275 SANDPIPER CT
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-1320
Practice Address - Country:US
Practice Address - Phone:650-815-8632
Practice Address - Fax:650-615-9995
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA981199242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist