Provider Demographics
NPI:1558346924
Name:UC DAVIS MEDICAL CENTEWR
Entity Type:Organization
Organization Name:UC DAVIS MEDICAL CENTEWR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MANSFIELD
Authorized Official - Middle Name:FW
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-734-2801
Mailing Address - Street 1:2521 STOCKTON BLVD
Mailing Address - Street 2:#7200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817
Mailing Address - Country:US
Mailing Address - Phone:916-734-2801
Mailing Address - Fax:916-456-7509
Practice Address - Street 1:2521 STOCKTON BLVD
Practice Address - Street 2:#7200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817
Practice Address - Country:US
Practice Address - Phone:916-734-2801
Practice Address - Fax:916-456-7509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG4531174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty