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General NPI Number Information
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NPI Number | 1932761939
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Entity Type | Organization
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Legal Business Name | PREMIUM TRANSPORT CORP
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Dates
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Enumeration Date | 07/01/2019
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Last Update Date | 07/01/2019
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Provider Practice Location Address
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Address Line | 12210 SW 130TH ST
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City | MIAMI
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State | FL
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Zip | 33186-6217
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Country | US
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Telephone | 786-634-8659
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Fax |
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Provider Business Mailing Address
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Address Line | 12210 SW 130TH ST
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City | MIAMI
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State | FL
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Zip | 33186-6217
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Country | US
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Telephone | 786-634-8659
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YOLEXIS FUENTES
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Credential |
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Telephone | 305-905-8272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number |
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License Number State |
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