Provider Demographics
NPI:1710479464
Name:STAR HEALTH MEDICAL TRANSPORT INC
Entity Type:Organization
Organization Name:STAR HEALTH MEDICAL TRANSPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YAILIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PESQUERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-549-5000
Mailing Address - Street 1:PO BOX 3978
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-3978
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1608 CALLE BORIS
Practice Address - Street 2:EDIF LA ELECTRONICA OFIC 222
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-549-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========Medicaid