Provider Information for 1760611628
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CLIFTON ISAIAH DAVIS
Sex: Male
NPI: 1760611628
Last Updated: 2016-03-31
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1760611628 | ||||||||
| Enumeration Date | 2009-07-13 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 108 W VICTORIA ST GARDENA, CA 90248-3523 United States Phone: 310-715-2020 | Fax: | ||||||||
| Primary Practice Address | 108 W VICTORIA ST GARDENA, CA 90248-3523 United States Phone: 310-715-2020 | Fax: | ||||||||
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