MEDICARE: DOLTOM TRANSPORTATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)	06-00066602	CA

General Provider Information

NPI Number	:	1679685655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOLTOM TRANSPORTATION

Provider Business Mailing Address
First Line	:	4910 VIOLET CT
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95212-3008
Country	:	US
Telephone Number	:	209-957-2855
Fax Number	:	209-957-7993

Provider Business Practice Location Address
First Line	:	4910 VIOLET CT
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95212-3008
Country	:	US
Telephone Number	:	209-957-2855
Fax Number	:	209-957-7993

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. TOYIN OLADAPO OLOGUNDUDU
Credential	:	M.D
Telephone Number	:	209-957-2855

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/22/2020

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