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General NPI Number Information
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NPI Number | 1962917161
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Entity Type | Organization
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Legal Business Name | PRO MED TRANSIT
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Dates
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Enumeration Date | 12/10/2017
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Last Update Date | 12/10/2017
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Provider Practice Location Address
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Address Line | 8411 HERON POND DR APT 110
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City | LEHIGH ACRES
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State | FL
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Zip | 33972-8549
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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 | PO BOX 516
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City | LEHIGH ACRES
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State | FL
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Zip | 33970-0516
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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 | OPERATIONS
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Name | MR. MIGUEL A PUENTES JR.
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Credential | EXECUTIVE
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Telephone | 239-288-9470
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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 | P532-541-79-263-0
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License Number State | FL
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