Provider Demographics
NPI:1558194472
Name:DAVIS, JACINTA R (CCMA, CPC, CPB)
Entity type:Individual
Prefix:MRS
First Name:JACINTA
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CCMA, CPC, CPB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 PORTAGE RD STE C138
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628-6191
Mailing Address - Country:US
Mailing Address - Phone:574-366-2291
Mailing Address - Fax:
Practice Address - Street 1:3903 PORTAGE RD STE C138
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-6191
Practice Address - Country:US
Practice Address - Phone:574-366-2291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN246Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information