Provider Demographics
NPI:1548454713
Name:UC DAVIS HEMOPHILIA PROGRAM
Entity type:Organization
Organization Name:UC DAVIS HEMOPHILIA PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, HEMOPHILIA TREATMENT CTR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUCORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-734-3461
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?:Yes
Parent Organization LBN:UNIVERSITY OF CALIFORNIA, DAVIS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-30
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG062311207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty