Healthcare Provider Details

I. General information

NPI: 1225478902
Provider Name (Legal Business Name): JUANITA'S TRANSPORT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3996 N PLANTATION RD
DOUGLAS AZ
85607-6029
US

IV. Provider business mailing address

3996 N PLANTATION RD
DOUGLAS AZ
85607-6029
US

V. Phone/Fax

Practice location:
  • Phone: 520-227-1821
  • Fax: 520-226-8507
Mailing address:
  • Phone: 520-227-1821
  • Fax: 520-226-8507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number StateAZ

VIII. Authorized Official

Name: MR. JESSE HECTOR FIGUEROA
Title or Position: CEO
Credential:
Phone: 520-227-1821