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General NPI Number Information
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NPI Number | 1518472810
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Entity Type | Individual
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Provider Name | MIGUEL A PUENTES JR. NEMT TRANSPORTER
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Gender | Male
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Dates
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Enumeration Date | 12/08/2017
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Last Update Date | 12/08/2017
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Provider Practice Location Address
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Address Line | 8411 HERON POND DR APT B110
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City | LEHIGH ACRES
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State | FL
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Zip | 33972-8548
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Country | US
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Telephone | 239-288-9470
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Fax |
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Provider Business Mailing Address
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Address Line | 8411 HERON POND DR APT B110
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City | LEHIGH ACRES
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State | FL
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Zip | 33972-8548
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Country | US
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Telephone | 239-288-9470
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | P532-541-79-263-0
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | P532-541-79-263-0
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License Number State | FL
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