Provider Demographics
NPI:1790007706
Name:DAVIS, DEANNA ALLYN (RHT ARRT RT)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:ALLYN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RHT ARRT RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1080 EMELINE AVENUE
Mailing Address - Street 2:CLINIC ADMIN
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-1966
Mailing Address - Country:US
Mailing Address - Phone:831-454-4587
Mailing Address - Fax:831-454-4893
Practice Address - Street 1:9 CRESTVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2723
Practice Address - Country:US
Practice Address - Phone:831-763-8400
Practice Address - Fax:831-763-8237
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CARHT20284247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist