Active NPI
Angela Michelle Davis, M.S.,CCC-SLP
- Speech-Language Pathologist
- San Diego, CA
National Provider Identifier
1306092515
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 18624
- Practice address
- 4639 35TH St Unit 1
San Diego, CA 92116-3571 - Phone
- (213) 458-8815
- NPI assigned
- Aug 7, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SP-2129-0 | HI | |
| Speech-Language Pathologist | 235Z00000X | 18624 | CA | Primary |
Addresses
Primary practice location
4639 35TH St Unit 1
San Diego, CA 92116-3571
Mailing address
PO Box 7406
Torrance, CA 90504-8806
Phone (213) 458-8815
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18624 | CA | MD | Addiction (Substance Use Disorder) Counselor |
| SP-2129-0 | HI | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sprouts Therapy LLC | Speech-Language Pathologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatric Occupational Therapist
- Waipahu, HI
- NPI 1760766869
Speech-Language Pathologist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1657065600000",
"number": "1306092515",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7406",
"city": "TORRANCE",
"state": "CA",
"postal_code": "905048806",
"telephone_number": "213-458-8815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4639 35TH ST UNIT 1",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921163571",
"telephone_number": "213-458-8815"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "ANGELA",
"middle_name": "MICHELLE",
"name_prefix": "Ms.",
"credential": "M.S.,CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-08-07",
"last_updated": "2022-07-06",
"certification_date": "2022-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "HI",
"license": "SP-2129-0",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "18624",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.