Healthcare Provider Details

I. General information

NPI: 1932758372
Provider Name (Legal Business Name): GENOMA TRANSPORT SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4621 LAKE WORTH RD
GREENACRES FL
33463-3451
US

IV. Provider business mailing address

4621 LAKE WORTH RD
GREENACRES FL
33463-3451
US

V. Phone/Fax

Practice location:
  • Phone: 561-403-6753
  • Fax: 561-410-5621
Mailing address:
  • Phone: 561-403-6753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYDEL MIRANDA
Title or Position: PRESIDENT
Credential:
Phone: 561-403-6753