Provider Demographics
NPI:1356779755
Name:URSOLUM, DANILO
Entity type:Individual
Prefix:
First Name:DANILO
Middle Name:
Last Name:URSOLUM
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 1:8807 THORNTON RD STE G
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-1862
Mailing Address - Country:US
Mailing Address - Phone:209-981-2112
Mailing Address - Fax:209-227-5219
Practice Address - Street 1:8807 THORNTON RD STE G
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-1862
Practice Address - Country:US
Practice Address - Phone:209-981-2112
Practice Address - Fax:209-227-5219
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-22
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14-00115305343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)