Provider Demographics
NPI:1235561879
Name:UNIVERSITY OF CALIFORNIA, DAVIS
Entity Type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA, DAVIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF LCSW
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCINIEGA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:916-734-3471
Mailing Address - Street 1:4920 HUTSON WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-3541
Mailing Address - Country:US
Mailing Address - Phone:916-715-4157
Mailing Address - Fax:
Practice Address - Street 1:4150 V ST STE 1300
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-734-2583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27572281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital