Provider Demographics
NPI:1346099421
Name:WHITAKER, ROY M JR
Entity type:Individual
Prefix:MR
First Name:ROY
Middle Name:M
Last Name:WHITAKER
Suffix:JR
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 1:3633 BROADLAND ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-3828
Mailing Address - Country:US
Mailing Address - Phone:916-949-6806
Mailing Address - Fax:
Practice Address - Street 1:3633 BROADLAND ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-3828
Practice Address - Country:US
Practice Address - Phone:916-949-6806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)