Healthcare Provider Details

I. General information

NPI: 1477076909
Provider Name (Legal Business Name): CUPS TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 07/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42639 WAXPOOL RD
ASHBURN VA
20148-4508
US

IV. Provider business mailing address

42639 WAXPOOL RD
ASHBURN VA
20148-4508
US

V. Phone/Fax

Practice location:
  • Phone: 571-268-9858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JUAN R ILLESCA ROMERO
Title or Position: OWNER
Credential:
Phone: 571-268-9858