Provider Demographics
NPI:1033553425
Name:UC DAVIS HEALTH SYSTEM
Entity Type:Organization
Organization Name:UC DAVIS HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIETITIAN II
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:STEFANO
Authorized Official - Last Name:NELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-367-0763
Mailing Address - Street 1:2315 STOCKTON BLVD
Mailing Address - Street 2:SESP OP160
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2315 STOCKTON BLVD
Practice Address - Street 2:SESP OP160
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2201
Practice Address - Country:US
Practice Address - Phone:916-703-3118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1034086261QM1300X, 284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1034086OtherCADE (COMMISSION ON ACCREDITATION FOR DIETETICS EDUCATION)