Healthcare Provider Details

I. General information

NPI: 1265469704
Provider Name (Legal Business Name): LEAH S TZIMENATOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD UC DAVIS MEDICAL CENTER DEPT OF EMERGENCY MEDICINE
SACRAMENTO CA
95817
US

IV. Provider business mailing address

2315 STOCKTON BLVD PSSB 2100 UC DAVIS MEDICAL CENTER DEPT OF EMERGENCY MEDICINE
SACRAMENTO CA
95817
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5010
  • Fax: 916-734-7950
Mailing address:
  • Phone: 916-734-5010
  • Fax: 916-734-7950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number35084138
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberA100330
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: