Provider Demographics
NPI:1699746958
Name:DAVIES, JOANNA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:MARIE
Last Name:DAVIES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 W 6TH ST
Mailing Address - Street 2:#307
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1805
Mailing Address - Country:US
Mailing Address - Phone:213-977-1144
Mailing Address - Fax:213-482-2182
Practice Address - Street 1:1136 W 6TH ST
Practice Address - Street 2:#307
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1805
Practice Address - Country:US
Practice Address - Phone:213-977-1144
Practice Address - Fax:213-482-2182
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51148207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG51148AMedicare ID - Type Unspecified
CAA93040Medicare UPIN