Active NPI
Marvin Lee Davis Jr., BS
- Rehabilitation Practitioner
- Elk Grove, CA
National Provider Identifier
1326798604
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- Practice address
- 9412 Big Horn Blvd Ste 6
Elk Grove, CA 95758-1101 - Phone
- (916) 396-4906
- NPI assigned
- Mar 28, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | CA | Primary |
Addresses
Primary practice location
9412 Big Horn Blvd Ste 6
Elk Grove, CA 95758-1101
Mailing address
9412 Big Horn Blvd Ste 6
Elk Grove, CA 95758-1101
Phone (916) 396-4906
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
- Bachelor of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1746576000000",
"number": "1326798604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9412 BIG HORN BLVD STE 6",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "957581101",
"telephone_number": "916-396-4906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9412 BIG HORN BLVD STE 6",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "957581101",
"telephone_number": "916-396-4906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "MARVIN",
"middle_name": "LEE",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "BS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-03-28",
"last_updated": "2025-05-07",
"certification_date": "2025-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elk Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.