Provider Demographics
NPI:1720063910
Name:UNIVERSITY OF CALIFORNIA, DAVIS MEDICAL CENTER
Entity Type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA, DAVIS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FELLOW
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-734-3815
Mailing Address - Street 1:3215 RYER ISLAND ST
Mailing Address - Street 2:
Mailing Address - City:W SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-5832
Mailing Address - Country:US
Mailing Address - Phone:916-617-2673
Mailing Address - Fax:
Practice Address - Street 1:4150 V ST
Practice Address - Street 2:PSSB, G500
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-734-3815
Practice Address - Fax:916-734-7766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82251282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA82251OtherCA STATE LICENSE
CABM8274691OtherDEA LICENSE