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General NPI Number Information
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NPI Number | 1104204353
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Entity Type | Organization
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Legal Business Name | LOGISTIC TRANSPORTATION LLC
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Dates
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Enumeration Date | 05/08/2015
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Last Update Date | 05/08/2015
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Provider Practice Location Address
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Address Line | 301 EDGEWATER PL 100
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City | WAKEFIELD
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State | MA
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Zip | 01880
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Country | US
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Telephone | 978-509-1791
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Fax |
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Provider Business Mailing Address
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Address Line | 301 EDGEWATER PL STE 100
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City | WAKEFIELD
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State | MA
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Zip | 01880-1281
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Country | US
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Telephone | 978-509-1791
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MELVIN BAUTISTA
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Credential |
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Telephone | 978-475-7070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number | S08819860
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License Number State | MA
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