Provider Demographics
NPI:1922579754
Name:EAFR GALLO ENTERPRISE CORPORATION
Entity Type:Organization
Organization Name:EAFR GALLO ENTERPRISE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-577-5825
Mailing Address - Street 1:3001 SW COLLEGE ROAD
Mailing Address - Street 2:PMB 201
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474
Mailing Address - Country:US
Mailing Address - Phone:512-577-5825
Mailing Address - Fax:
Practice Address - Street 1:5345 SE 103RD ST
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-3291
Practice Address - Country:US
Practice Address - Phone:512-577-5825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)