Healthcare Provider Details

I. General information

NPI: 1639933245
Provider Name (Legal Business Name): FLORIDA TRANSPORTATION SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W PALM DR
HOMESTEAD FL
33034-3344
US

IV. Provider business mailing address

302 W PALM DR
HOMESTEAD FL
33034-3344
US

V. Phone/Fax

Practice location:
  • Phone: 305-742-1622
  • Fax:
Mailing address:
  • Phone: 305-742-1622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. YOVANI PEREZ
Title or Position: PRES
Credential:
Phone: 305-742-1622