Provider Demographics
NPI:1013454701
Name:DAVIS, CIERA
Entity Type:Individual
Prefix:
First Name:CIERA
Middle Name:
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 1:3100 RIVERSIDE DR
Mailing Address - Street 2:APT 337
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-1474
Mailing Address - Country:US
Mailing Address - Phone:480-648-6575
Mailing Address - Fax:
Practice Address - Street 1:2471 N BEACHWOOD DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-3004
Practice Address - Country:US
Practice Address - Phone:323-962-0430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency