Provider Demographics
NPI:1427243427
Name:CABULLO, WILLIAM T
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:T
Last Name:CABULLO
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 1:5875 MONTAUBAN AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-5632
Mailing Address - Country:US
Mailing Address - Phone:209-481-6584
Mailing Address - Fax:
Practice Address - Street 1:5875 MONTAUBAN AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-5632
Practice Address - Country:US
Practice Address - Phone:209-481-6584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA08-00091765343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)