Provider Demographics
NPI:1205826351
Name:UC DAVIS MEDICAL CENTER
Entity Type:Organization
Organization Name:UC DAVIS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TASSANEE
Authorized Official - Middle Name:-
Authorized Official - Last Name:VISIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-734-5704
Mailing Address - Street 1:1114 HARVARD DR
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-1709
Mailing Address - Country:US
Mailing Address - Phone:530-759-8671
Mailing Address - Fax:
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:SUITE 3100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-5704
Practice Address - Fax:916-734-8490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA57022282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
H38621Medicare UPIN