Provider Demographics
NPI:1760536601
Name:UNIVERSITY OF CAIFORNIA, DAVIS MEDICAL CENTER
Entity Type:Organization
Organization Name:UNIVERSITY OF CAIFORNIA, DAVIS MEDICAL CENTER
Other - Org Name:UNIVERSITY OF CAIFORNIA, DAVIS MEDICAL CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
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 1:2315 STOCKTON BLVD
Mailing Address - Street 2:PSSB 1300
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2201
Mailing Address - Country:US
Mailing Address - Phone:916-734-2583
Mailing Address - Fax:916-734-0415
Practice Address - Street 1:2315 STOCKTON BLVD
Practice Address - Street 2:PSSB 1300
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2201
Practice Address - Country:US
Practice Address - Phone:916-734-2583
Practice Address - Fax:916-734-0415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAACSW 13674282N00000X, 282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered282N00000XHospitalsGeneral Acute Care Hospital
Not Answered282NC2000XHospitalsGeneral Acute Care HospitalChildren