Provider Demographics
NPI:1750700142
Name:OBATOLU, EMMANUEL A
Entity type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:A
Last Name:OBATOLU
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 1:1661 BELINDA WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-5109
Mailing Address - Country:US
Mailing Address - Phone:916-248-1618
Mailing Address - Fax:916-533-6648
Practice Address - Street 1:4100 WOODWILLOW LN
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-3959
Practice Address - Country:US
Practice Address - Phone:916-248-1618
Practice Address - Fax:916-533-6648
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFBN201309848343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)