Provider Demographics
NPI:1306579610
Name:DAVIS, CEDRIC TARON JR
Entity type:Individual
Prefix:
First Name:CEDRIC
Middle Name:TARON
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 EUCALYPTUS DR APT 732
Mailing Address - Street 2:
Mailing Address - City:AMERICAN CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94503-1177
Mailing Address - Country:US
Mailing Address - Phone:707-312-6413
Mailing Address - Fax:
Practice Address - Street 1:5500 EUCALYPTUS DR APT 732
Practice Address - Street 2:
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503-1177
Practice Address - Country:US
Practice Address - Phone:707-312-6413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker