MEDICARE: FARO LOGISTICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1801583174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARO LOGISTICS LLC

Provider Business Mailing Address
First Line	:	2417 BARLEY CLUB DR APT 2
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32837-7846
Country	:	US
Telephone Number	:	407-758-7784
Fax Number	:

Provider Business Practice Location Address
First Line	:	595 W CHURCH ST APT 611
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32805-2294
Country	:	US
Telephone Number	:	407-758-7784
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SERGIO LIESA
Credential	:
Telephone Number	:	407-758-7784

Provider Enumeration Date	:	04/18/2023
Last Update Date	:	04/19/2023

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Directions to “FARO LOGISTICS LLC ” Practice Location

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