MEDICARE: FAST CRUZ AMBULANCE CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	TC AMB 346	PR

General Provider Information

NPI Number	:	1982652210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAST CRUZ AMBULANCE CORP

Provider Business Mailing Address
First Line	:	PO BOX 1591
Second Line	:
City	:	SABANA SECA
State	:	PR
Zip	:	00952-1591
Country	:	US
Telephone Number	:	787-672-8275
Fax Number	:

Provider Business Practice Location Address
First Line	:	AVE BOULEVARD G-28
Second Line	:	4TA SECCION
City	:	TOA BAJA
State	:	PR
Zip	:	00949-0000
Country	:	US
Telephone Number	:	787-672-8275
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CARMEN CRUZ
Credential	:
Telephone Number	:	787-672-8275

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	01/21/2010

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