Healthcare Provider Details

I. General information

NPI: 1629643911
Provider Name (Legal Business Name): MARQUENSY TRAJEAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10736 BANFIELD DR
RIVERVIEW FL
33579-7782
US

IV. Provider business mailing address

10736 BANFIELD DR
RIVERVIEW FL
33579-7782
US

V. Phone/Fax

Practice location:
  • Phone: 813-650-6988
  • Fax:
Mailing address:
  • Phone: 813-650-6988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MARQUENSY TRAJEAN
Title or Position: OWNER
Credential:
Phone: 813-650-6988