Provider Demographics
NPI:1316163462
Name:RATLIFF, MICHAEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:RATLIFF
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 1:5900 KING RD STE 209
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-7948
Mailing Address - Country:US
Mailing Address - Phone:916-824-2255
Mailing Address - Fax:800-881-8439
Practice Address - Street 1:5900 KING RD STE 209
Practice Address - Street 2:
Practice Address - City:LOOMIS
Practice Address - State:CA
Practice Address - Zip Code:95650
Practice Address - Country:US
Practice Address - Phone:916-824-2255
Practice Address - Fax:800-881-8439
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300145343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN01151FOtherMEDI - CAL PROVIDER NUMBE