Basic Information
| Provider Information | |||||||||
| NPI: | 1235561879 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY OF CALIFORNIA, DAVIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4920 HUTSON WAY | ||||||||
| Address2: | |||||||||
| City: | ELK GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957573541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167154157 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4150 V ST STE 1300 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958171460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167342583 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2013 | ||||||||
| LastUpdateDate: | 08/06/2013 | ||||||||
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| AuthorizedOfficialLastName: | ARCINIEGA | ||||||||
| AuthorizedOfficialFirstName: | THERESA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF LCSW | ||||||||
| AuthorizedOfficialTelephone: | 9167343471 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 281P00000X | 27572 | CA | Y | Hospitals | Chronic Disease Hospital |
No ID Information.