Healthcare Provider Details

I. General information

NPI: 1518472810
Provider Name (Legal Business Name): MIGUEL A PUENTES JR. NEMT TRANSPORTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2017
Last Update Date: 12/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8411 HERON POND DR APT B110
LEHIGH ACRES FL
33972-8548
US

IV. Provider business mailing address

8411 HERON POND DR APT B110
LEHIGH ACRES FL
33972-8548
US

V. Phone/Fax

Practice location:
  • Phone: 239-288-9470
  • Fax:
Mailing address:
  • Phone: 239-288-9470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberP532-541-79-263-0
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberP532-541-79-263-0
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: