Provider Demographics
NPI:1043709926
Name:QUERO, LUIS ALBERTO
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ALBERTO
Last Name:QUERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9712 KINGS CANYON PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-1094
Mailing Address - Country:US
Mailing Address - Phone:813-408-3420
Mailing Address - Fax:
Practice Address - Street 1:9712 KINGS CANYON PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-1094
Practice Address - Country:US
Practice Address - Phone:813-408-3420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-06
Last Update Date:2018-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherVEYO
FLNAOtherNA
NAOtherLOGISTIC CARE
FLNAOtherNATIONAL MED TRANS