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General NPI Number Information
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NPI Number | 1720063910
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF CALIFORNIA, DAVIS MEDICAL CENTER
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Dates
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Enumeration Date | 12/09/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 4150 V ST PSSB, G500
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City | SACRAMENTO
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State | CA
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Zip | 95817-1460
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Country | US
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Telephone | 916-734-3815
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Fax | 916-734-7766
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Provider Business Mailing Address
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Address Line | 3215 RYER ISLAND ST
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City | W SACRAMENTO
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State | CA
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Zip | 95691-5832
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Country | US
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Telephone | 916-617-2673
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Fax |
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Authorized Official
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Title or Position | FELLOW
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Name | MATTHEW SCOTT MILES
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Credential | MD
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Telephone | 916-734-3815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | A82251
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License Number State | CA
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