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General NPI Number Information
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NPI Number | 1164605838
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Entity Type | Organization
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Legal Business Name | UC DAVIS MEDICAL CENTER
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Dates
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Enumeration Date | 12/17/2007
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 2521 STOCKTON BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95817-2207
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Country | US
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Telephone | 916-734-7006
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Fax | 916-734-1357
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Provider Business Mailing Address
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Address Line | 2521 STOCKTON BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95817-2207
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Country | US
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Telephone | 916-734-7006
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Fax | 916-734-1357
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Authorized Official
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Title or Position | REGISTERED NURSE
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Name | MRS. YVONNE LOUISE ROACH
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Credential |
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Telephone | 916-734-7006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 397650
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License Number State | CA
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