Provider Demographics
NPI:1972879385
Name:DAVIS, SEAN ERIC (LAC)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:ERIC
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5465 MOREHOUSE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4713
Mailing Address - Country:US
Mailing Address - Phone:858-255-8070
Mailing Address - Fax:858-750-2428
Practice Address - Street 1:5465 MOREHOUSE DR STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4713
Practice Address - Country:US
Practice Address - Phone:858-255-8070
Practice Address - Fax:858-750-2428
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14401171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist