Healthcare Provider Details

I. General information

NPI: 1801040928
Provider Name (Legal Business Name): JIRAU AMBULANCE SERVICE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 111 INT 602
ANGELES PR
00611-0099
US

IV. Provider business mailing address

PO BOX 99
ANGELES PR
00611-0099
US

V. Phone/Fax

Practice location:
  • Phone: 787-933-6781
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number559
License Number StatePR

VIII. Authorized Official

Name: MR. EDGARDO JAVIER JIRAU SOTO
Title or Position: PRESIDENT
Credential:
Phone: 787-933-6781