Organization
MYSTICAL MEDICAL TRANSPORT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIETER NOEL OLIVERA (OWNER)
(239) 699-4106
Entity
Organization
Contact information
Practice address
1641 NORTH DR, FORT MYERS, FL 33907-1114
(239) 699-4106
Mailing address
1641 NORTH DR, FORT MYERS, FL 33907-1114
(239) 699-4106
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
01/02/2024
Last updated
01/02/2024
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