Provider Demographics
NPI:1275870412
Name:UC DAVIS HOSPITAL
Entity Type:Organization
Organization Name:UC DAVIS HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRISIS SERVICES SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:NORDSTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:707-372-1634
Mailing Address - Street 1:2005 KINGSTON DR
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-4549
Mailing Address - Country:US
Mailing Address - Phone:707-372-1634
Mailing Address - Fax:
Practice Address - Street 1:2315 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2201
Practice Address - Country:US
Practice Address - Phone:916-734-2011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access