Healthcare Provider Details

I. General information

NPI: 1629052220
Provider Name (Legal Business Name): FREDRIC AUSTIN GORIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST STE 3700 DEPT OF NEUROLOGY UC DAVIS MEDICAL CENTER
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

4860 Y ST SUITE 3700
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3588
  • Fax:
Mailing address:
  • Phone: 916-734-6280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberG44069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: