Provider Demographics
NPI:1154302727
Name:UNIVERSITY OF CALIFORNIA, DAVIS, MEDICAL CENTER
Entity Type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA, DAVIS, MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT PROFESSOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:GOPAL
Authorized Official - Last Name:LAURIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-734-5016
Mailing Address - Street 1:2315 STOCKTON BLVD
Mailing Address - Street 2:PSSB 2100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2201
Mailing Address - Country:US
Mailing Address - Phone:916-734-5016
Mailing Address - Fax:
Practice Address - Street 1:2315 STOCKTON BLVD
Practice Address - Street 2:PSSB 2100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2201
Practice Address - Country:US
Practice Address - Phone:916-734-5016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA064389282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92703Medicare UPIN