Provider Demographics
NPI:1831814508
Name:DAVIS, CALVIN TRAVON (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:CALVIN
Middle Name:TRAVON
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15632 HASKINS AVE.
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220
Mailing Address - Country:US
Mailing Address - Phone:323-203-4678
Mailing Address - Fax:
Practice Address - Street 1:4580 PACIFIC BLVD. (STACY MEDICAL CENTER)
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CA
Practice Address - Zip Code:90058
Practice Address - Country:US
Practice Address - Phone:323-584-0779
Practice Address - Fax:323-582-2282
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA15426363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical