Provider Demographics
NPI:1356963151
Name:DAVIS GROUP MEDICAL CONSULTANTS, INC.
Entity type:Organization
Organization Name:DAVIS GROUP MEDICAL CONSULTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:949-632-9990
Mailing Address - Street 1:1024 BAYSIDE DR STE 156
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7462
Mailing Address - Country:US
Mailing Address - Phone:949-520-7170
Mailing Address - Fax:949-520-7171
Practice Address - Street 1:27201 PUERTA REAL STE 300
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8590
Practice Address - Country:US
Practice Address - Phone:949-632-9990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty