Healthcare Provider Details

I. General information

NPI: 1760985923
Provider Name (Legal Business Name): SERVICIOS Y REPARACIONES NAZARETH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 LAKE ELLENOR DR STE 144
ORLANDO FL
32809-5787
US

IV. Provider business mailing address

7200 LAKE ELLENOR DR STE 144
ORLANDO FL
32809-5787
US

V. Phone/Fax

Practice location:
  • Phone: 407-734-5081
  • Fax:
Mailing address:
  • Phone: 407-734-5081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHNY JADALLA MARIA
Title or Position: OWNER
Credential:
Phone: 407-734-5081