Provider Demographics
NPI:1144603770
Name:MARBELLA MEDICAL TRANSPORT & PRIVATE SERVICES,LLC
Entity type:Organization
Organization Name:MARBELLA MEDICAL TRANSPORT & PRIVATE SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:MRS
Authorized Official - Phone:813-770-8443
Mailing Address - Street 1:215 E SLIGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-5547
Mailing Address - Country:US
Mailing Address - Phone:813-770-8443
Mailing Address - Fax:
Practice Address - Street 1:215 E SLIGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-5547
Practice Address - Country:US
Practice Address - Phone:813-770-8443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL343800000X
3416L0300X, 341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMARBELLA2Medicare UPIN