Provider Demographics
NPI:1629478144
Name:GULLATTE, SAMMY DAVID
Entity Type:Individual
Prefix:MR
First Name:SAMMY
Middle Name:DAVID
Last Name:GULLATTE
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 1:10 W MINNEZONA AVE APT 1036
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4926
Mailing Address - Country:US
Mailing Address - Phone:408-421-6939
Mailing Address - Fax:480-758-5187
Practice Address - Street 1:10 W MINNEZONA AVE APT 1036
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4926
Practice Address - Country:US
Practice Address - Phone:408-421-6939
Practice Address - Fax:498-980-5872
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)