Provider Demographics
NPI:1992058374
Name:DAVIES, DEBRA S (MSTOM)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:S
Last Name:DAVIES
Suffix:
Gender:F
Credentials:MSTOM
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:S
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSTOM
Mailing Address - Street 1:1831 FELTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-1229
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1831 FELTON ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-1229
Practice Address - Country:US
Practice Address - Phone:619-917-9550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12974171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist