Provider Demographics
NPI:1487227278
Name:CUSOLITO, PRICE DAVID
Entity Type:Individual
Prefix:
First Name:PRICE
Middle Name:DAVID
Last Name:CUSOLITO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18038 PENN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:PENN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95946-9341
Mailing Address - Country:US
Mailing Address - Phone:805-448-2733
Mailing Address - Fax:
Practice Address - Street 1:8401 JACKSON RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3904
Practice Address - Country:US
Practice Address - Phone:916-453-1482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program