Provider Demographics
NPI:1609961127
Name:MILSAP, DONALD
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:
Last Name:MILSAP
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 1:3941 PARK DR
Mailing Address - Street 2:#20-316
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762
Mailing Address - Country:US
Mailing Address - Phone:916-933-4509
Mailing Address - Fax:916-933-4508
Practice Address - Street 1:3941 PARK DR
Practice Address - Street 2:#20-316
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762
Practice Address - Country:US
Practice Address - Phone:916-933-4509
Practice Address - Fax:916-933-4508
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMTN01077F343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN01077FMedicaid