=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811993900
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2315 STOCKTON BLVD
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95817-2201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-734-0855
-----------------------------------------------------
Fax | 916-734-1660
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2315 STOCKTON BLVD
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95817-2201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-734-0855
-----------------------------------------------------
Fax | 916-734-1660
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER III
-----------------------------------------------------
Name | MS. JO ANN BRYAN
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 916-734-0855
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | NP11917
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------