=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215200712
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UC DAVIS MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2012
-----------------------------------------------------
Last Update Date | 02/14/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4860 Y ST 1100, UC DAVIS MEDICAL CENTER
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-734-6718
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4057 ARAGON WAY
-----------------------------------------------------
City | RANCHO CORDOVA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95742-8005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-734-6718
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HEAD SPEECH PATHOLOGIST
-----------------------------------------------------
Name | DR. CHRISTINE DAVIS
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 916-734-6730
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | D2916188
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------