Basic Information
| Provider Information | |||||||||
| NPI: | 1578856811 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UCD MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2730 STOCKTON BLVD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958172217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167342583 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2315 STOCKTON BLVD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958172201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167342583 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2011 | ||||||||
| LastUpdateDate: | 05/19/2011 | ||||||||
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| AuthorizedOfficialLastName: | PRATT | ||||||||
| AuthorizedOfficialFirstName: | WANDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 9167342583 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | LCS17366 | CA | Y | Hospital Units | Psychiatric Unit |
No ID Information.