Provider Demographics
NPI:1093860033
Name:UC DAVIS
Entity Type:Organization
Organization Name:UC DAVIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:KITTY
Authorized Official - Middle Name:OLIVIA
Authorized Official - Last Name:OLMOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:916-734-8738
Mailing Address - Street 1:2521 STOCKTON BLVD STE 3200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2207
Mailing Address - Country:US
Mailing Address - Phone:916-734-0561
Mailing Address - Fax:
Practice Address - Street 1:2521 STOCKTON BLVD STE 3200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2207
Practice Address - Country:US
Practice Address - Phone:916-734-0561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 22384282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital