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General NPI Number Information
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NPI Number | 1033553425
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Entity Type | Organization
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Legal Business Name | UC DAVIS HEALTH SYSTEM
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Dates
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Enumeration Date | 04/29/2013
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Last Update Date | 04/29/2013
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Provider Practice Location Address
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Address Line | 2315 STOCKTON BLVD SESP OP160
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City | SACRAMENTO
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State | CA
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Zip | 95817-2201
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Country | US
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Telephone | 916-703-3118
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Fax |
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Provider Business Mailing Address
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Address Line | 2315 STOCKTON BLVD SESP OP160
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City | SACRAMENTO
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State | CA
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Zip | 95817-2201
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIETITIAN II
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Name | ALEXANDER STEFANO NELLA
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Credential |
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Telephone | 707-367-0763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 1034086
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 284300000X
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Taxonomy Name | Special Hospital
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License Number | 1034086
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License Number State | CA
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