Provider Demographics
NPI:1518472810
Name:PUENTES, MIGUEL A JR (NEMT TRANSPORTER)
Entity Type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:A
Last Name:PUENTES
Suffix:JR
Gender:M
Credentials:NEMT TRANSPORTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8411 HERON POND DR APT B110
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33972-8548
Mailing Address - Country:US
Mailing Address - Phone:239-288-9470
Mailing Address - Fax:
Practice Address - Street 1:8411 HERON POND DR APT B110
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33972-8548
Practice Address - Country:US
Practice Address - Phone:239-288-9470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP532-541-79-263-0347C00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle