Basic Information
| Provider Information | |||||||||
| NPI: | 1982623971 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | ANISSA | ||||||||
| MiddleName: | DANIELLE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2525 GRAND AVENUE | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5625704047 | ||||||||
| FaxNumber: | 5625986220 | ||||||||
| Practice Location | |||||||||
| Address1: | 2525 GRAND AVENUE | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5625704047 | ||||||||
| FaxNumber: | 5625986220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 11/08/2017 | ||||||||
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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 | 207Q00000X | A71328 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.