Provider Demographics
NPI:1205161593
Name:BABATUNDE, SAMUEL O (CEO)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:O
Last Name:BABATUNDE
Suffix:
Gender:M
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8009 NORTHERN OAK CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-6380
Mailing Address - Country:US
Mailing Address - Phone:916-335-0682
Mailing Address - Fax:209-727-4365
Practice Address - Street 1:8009 NORTHERN OAK CIR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-6380
Practice Address - Country:US
Practice Address - Phone:916-335-0682
Practice Address - Fax:209-727-4365
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)