Basic Information
| Provider Information | |||||||||
| NPI: | 1821564782 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVES | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1509 HIBISCUS LN | ||||||||
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| City: | LAREDO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780413324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9562854622 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2499 S WILMINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | COMPTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902205434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106381113 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2018 | ||||||||
| LastUpdateDate: | 10/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 294482 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.