Provider Demographics
NPI:1174754469
Name:DAVIS, JAIMIE N (PHD, RD)
Entity type:Individual
Prefix:DR
First Name:JAIMIE
Middle Name:N
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 S CRAIG AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-5066
Mailing Address - Country:US
Mailing Address - Phone:323-442-3066
Mailing Address - Fax:323-442-3066
Practice Address - Street 1:2250 ALCAZAR STREET
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-442-3066
Practice Address - Fax:323-442-4103
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study