Basic Information
| Provider Information | |||||||||
| NPI: | 1861034795 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | JANET | ||||||||
| MiddleName: | CATHERINE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LVN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40700 CALIFORNIA OAKS RD | ||||||||
| Address2: | |||||||||
| City: | MURRIETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925625795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9518945072 | ||||||||
| FaxNumber: | 9518947324 | ||||||||
| Practice Location | |||||||||
| Address1: | 40700 CALIFORNIA OAKS RD | ||||||||
| Address2: | |||||||||
| City: | MURRIETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925625795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9518945072 | ||||||||
| FaxNumber: | 9518947324 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2019 | ||||||||
| LastUpdateDate: | 10/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 232445 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
ID Information
| ID | Type | State | Issuer | Description | 1578665790 | 05 | CA | MEDICAID |