Provider Demographics
NPI:1053620161
Name:UNIVERSITY OF CALIFORNIA, DAVIS
Entity type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA, DAVIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEMOTOLOGY ONCOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-734-8616
Mailing Address - Street 1:2360 STOCKTON BLVD STE 1100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2283
Mailing Address - Country:US
Mailing Address - Phone:916-734-3461
Mailing Address - Fax:916-734-3591
Practice Address - Street 1:2360 STOCKTON BLVD STE 1100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2283
Practice Address - Country:US
Practice Address - Phone:916-734-3461
Practice Address - Fax:916-734-3591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24419281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital