Provider Demographics
NPI:1295951887
Name:DAVIS, RICH (LVN)
Entity type:Individual
Prefix:MR
First Name:RICH
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2571 FULTON SQUARE LN
Mailing Address - Street 2:# 64
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-2382
Mailing Address - Country:US
Mailing Address - Phone:916-972-9922
Mailing Address - Fax:
Practice Address - Street 1:2571 FULTON SQUARE LN
Practice Address - Street 2:# 64
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-2382
Practice Address - Country:US
Practice Address - Phone:916-972-9922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN171232164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPAO860OtherALTA REGIONAL VENDOR #
CAEPS013620OtherMEDI-CAL PED PROVIDER #
CARVN002000OtherMEDI-CAL ADULT PROVIDER