Provider Demographics
NPI:1134248339
Name:MICHAEL G. DAVIS
Entity type:Organization
Organization Name:MICHAEL G. DAVIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-538-4730
Mailing Address - Street 1:1941 MITCHELL RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-2434
Mailing Address - Country:US
Mailing Address - Phone:209-538-4730
Mailing Address - Fax:209-538-4794
Practice Address - Street 1:1941 MITCHELL RD
Practice Address - Street 2:SUITE K
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-2434
Practice Address - Country:US
Practice Address - Phone:209-538-4730
Practice Address - Fax:209-538-4794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ17009ZMedicare UPIN