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General NPI Number Information
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NPI Number | 1477691368
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Entity Type | Organization
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Legal Business Name | UCDAVIS
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 08/22/2020
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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 | 95867-0001
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Country | US
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Telephone | 916-734-2347
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Fax |
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Provider Business Mailing Address
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Address Line | 6422 EMERALD DR
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City | ROCKLIN
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State | CA
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Zip | 95677-4732
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Country | US
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Telephone | 916-624-7001
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Fax |
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Authorized Official
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Title or Position | RN FACIAL PLASTICS
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Name | BARBARA ANN TAYLOR
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Credential | RN
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Telephone | 916-734-2347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | CA
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