Provider Demographics
NPI:1477691368
Name:UCDAVIS
Entity Type:Organization
Organization Name:UCDAVIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN FACIAL PLASTICS
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:916-734-2347
Mailing Address - Street 1:6422 EMERALD DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-4732
Mailing Address - Country:US
Mailing Address - Phone:916-624-7001
Mailing Address - Fax:
Practice Address - Street 1:2521 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95867-0001
Practice Address - Country:US
Practice Address - Phone:916-734-2347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA07962OtherUNIVERSITY PIN