Provider Demographics
NPI:1992342596
Name:EE BIDOT L GROUP CORPORATION
Entity type:Organization
Organization Name:EE BIDOT L GROUP CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:BIDOT
Authorized Official - Suffix:
Authorized Official - Credentials:DRIVER
Authorized Official - Phone:787-543-7895
Mailing Address - Street 1:2515 CALLE ALAMAR COND ALAMBRA PLAZA
Mailing Address - Street 2:APART 205
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-543-7895
Mailing Address - Fax:
Practice Address - Street 1:2515 CALLE ALAMAR COND ALAMBRA PLAZA
Practice Address - Street 2:APART 205
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-543-7895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-03
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1538703616Medicaid