Organization
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VINCENT SAM FONG ACSW 16761 (PEDIATRIC SOCIAL WORKER)
(916) 734-1665
Entity
Organization
Contact information
Practice address
2521 STOCKTON BLVD STE 3110, SACRAMENTO, CA 95817-2207
(916) 734-1665
(916) 734-0561
Mailing address
3304 MONTE VISTA AVE, DAVIS, CA 95618
(530) 758-5385
(916) 734-0561
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ASW 16761
CLINICAL SOCIAL WORKER
CA
Enumeration date
04/11/2007
Last updated
08/22/2020
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