Provider Information for 1053069120
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CHRISTINA DAVIS
Sex: Female
NPI: 1053069120
Last Updated: 2023-10-18
Certification Date: 2023-10-18
Certification Date: 2023-10-18
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1053069120 | ||||||||||||||
| Enumeration Date | 2022-03-16 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | YES | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 4122 SUNRISE COVE DR SAN ANTONIO, TX 78244-3311 United States Phone: 317-627-2483 | Fax: | ||||||||||||||
| Primary Practice Address | 7315 AUTUMN CT AVON, IN 46123-7403 United States Phone: 317-627-2483 | Fax: | ||||||||||||||
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