Provider Demographics
NPI:1306527619
Name:DAVIS, BERTA (PH D)
Entity type:Individual
Prefix:DR
First Name:BERTA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:DR
Other - First Name:BERTA
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DR BERTA DAVIS
Mailing Address - Street 1:2188 CENTURY WOODS WAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-6308
Mailing Address - Country:US
Mailing Address - Phone:310-497-8813
Mailing Address - Fax:
Practice Address - Street 1:2188 CENTURY WOODS WAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-6308
Practice Address - Country:US
Practice Address - Phone:310-497-8813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7683103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical