Healthcare Provider Details

I. General information

NPI: 1255058665
Provider Name (Legal Business Name): MEDGO TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 10/26/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB PUERTO NUEVO AVE ANDALUCIA #505
SAN JUAN PR
00919
US

IV. Provider business mailing address

B5 ST. TABONUCO SUITE 216 PMB 192
GUAYNABO PR
00968-0096
US

V. Phone/Fax

Practice location:
  • Phone: 787-245-0000
  • Fax:
Mailing address:
  • Phone: 787-245-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSE J MORENO
Title or Position: VICEPRESIDENT
Credential: VP
Phone: 787-245-0000