Organization
U.C. DAVIS MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER D. SANTIAGO C.O. (CHIEF ORTHOTIST)
(916) 734-7045
Entity
Organization
Contact information
Practice address
2315 STOCKTON BLVD, SACRAMENTO, CA 95817-2201
(916) 734-7045
Mailing address
4961 PRISCILLA LN, SACRAMENTO, CA 95820-6123
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C.PED 1804
PEDORTHIST
CA
01
—
CO1419
ORTHOTIST
CA
Enumeration date
12/22/2005
Last updated
08/22/2020
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