Healthcare Provider Details

I. General information

NPI: 1477691368
Provider Name (Legal Business Name): UCDAVIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 STOCKTON BLVD
SACRAMENTO CA
95867-0001
US

IV. Provider business mailing address

6422 EMERALD DR
ROCKLIN CA
95677-4732
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2347
  • Fax:
Mailing address:
  • Phone: 916-624-7001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: BARBARA ANN TAYLOR
Title or Position: RN FACIAL PLASTICS
Credential: RN
Phone: 916-734-2347