Healthcare Provider Details

I. General information

NPI: 1851022412
Provider Name (Legal Business Name): MIA TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB SANTA JUANITA CALLE 24 AU-13
BAYAMON PR
00956
US

IV. Provider business mailing address

URB LOMAS VERDES CALLE SALVIA 4K4
BAYAMON PR
00956
US

V. Phone/Fax

Practice location:
  • Phone: 939-475-7723
  • Fax:
Mailing address:
  • Phone: 939-475-7723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MARIE L MATOS
Title or Position: PROPIETARIO
Credential:
Phone: 939-475-7723