Provider Demographics
NPI:1255340568
Name:DAVAINIS, PAUL C (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:C
Last Name:DAVAINIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 PLACER ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1125
Mailing Address - Country:US
Mailing Address - Phone:530-246-5710
Mailing Address - Fax:
Practice Address - Street 1:2965 EAST ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:CA
Practice Address - Zip Code:96007
Practice Address - Country:US
Practice Address - Phone:530-378-0486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080119610OtherRAILROAD MEDICARE
CA942492609OtherTAX ID NUMBER
G19858Medicare UPIN