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General NPI Number Information
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NPI Number | 1558346924
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Entity Type | Organization
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Legal Business Name | UC DAVIS MEDICAL CENTEWR
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Dates
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Enumeration Date | 12/08/2005
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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 #7200
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City | SACRAMENTO
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State | CA
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Zip | 95817
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Country | US
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Telephone | 916-734-2801
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Fax | 916-456-7509
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Provider Business Mailing Address
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Address Line | 2521 STOCKTON BLVD #7200
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City | SACRAMENTO
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State | CA
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Zip | 95817
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Country | US
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Telephone | 916-734-2801
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Fax | 916-456-7509
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Authorized Official
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Title or Position | PROFESSOR
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Name | DR. MANSFIELD FW SMITH
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Credential |
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Telephone | 916-734-2801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G4531
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License Number State | CA
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