Provider Demographics
NPI:1356678437
Name:DAVIS, REBECCA HIER (COTA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:HIER
Last Name:DAVIS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7025 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-0814
Mailing Address - Country:US
Mailing Address - Phone:909-429-6185
Mailing Address - Fax:
Practice Address - Street 1:4600 PEDLEY AVE
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-1533
Practice Address - Country:US
Practice Address - Phone:951-736-3245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA1633172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker