Healthcare Provider Details

I. General information

NPI: 1225423957
Provider Name (Legal Business Name): JULIUS EBINU M.D., PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

UNIVERSITY OF CALIFORNIA DAVIS, DEPT. NEUROSURGERY 4860 Y ST STE 3749
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 866-830-9125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number21048
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number284556
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA151022
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: