Provider Demographics
NPI:1255029831
Name:DAVIS, TONISHA DEGINA
Entity type:Individual
Prefix:
First Name:TONISHA
Middle Name:DEGINA
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 1:12609 EL DORADO PL
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-8066
Mailing Address - Country:US
Mailing Address - Phone:310-924-2858
Mailing Address - Fax:
Practice Address - Street 1:7177 BROCKTON AVE STE 221
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2633
Practice Address - Country:US
Practice Address - Phone:310-924-2858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst