=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023878444
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J & A PROFESIONAL TRANSPORTATION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2024
-----------------------------------------------------
Last Update Date | 03/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14438 AVALON RESERVE BLVD APT 201
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32828-5197
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-391-2466
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14438 AVALON RESERVE BLVD APT 201
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32828-5197
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-391-2466
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GM
-----------------------------------------------------
Name | JAIME RODRIGUEZ VAZQUEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 321-391-2466
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 347C00000X
-----------------------------------------------------
Taxonomy Name | Private Vehicle
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------