Provider Demographics
NPI:1093133340
Name:DAVENPORT, JILLIAN RENEE (MD)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:RENEE
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:230 STATION WAY STE B
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3383
Mailing Address - Country:US
Mailing Address - Phone:805-473-3262
Mailing Address - Fax:805-473-3707
Practice Address - Street 1:230 STATION WAY STE B
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3383
Practice Address - Country:US
Practice Address - Phone:805-473-3262
Practice Address - Fax:805-473-3707
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA140588208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics