Provider Demographics
NPI:1063114957
Name:DAVIS, CANDICE YVORE (CMT)
Entity type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:YVORE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 GREAT JONES ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6022
Mailing Address - Country:US
Mailing Address - Phone:707-603-5068
Mailing Address - Fax:
Practice Address - Street 1:332 GREAT JONES ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6022
Practice Address - Country:US
Practice Address - Phone:707-603-5068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88668225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist