Provider Demographics
NPI:1477597425
Name:JUPITER HOLDINGS CORPORATION
Entity type:Organization
Organization Name:JUPITER HOLDINGS CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINITRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:CORDERO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:956-618-5003
Mailing Address - Street 1:3750 W GARDENIA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-3381
Mailing Address - Country:US
Mailing Address - Phone:956-618-5003
Mailing Address - Fax:
Practice Address - Street 1:3750 W GARDENIA AVE STE B
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-3381
Practice Address - Country:US
Practice Address - Phone:956-618-5003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1084003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB422Medicare ID - Type UnspecifiedPROVIDER NUMBER