Healthcare Provider Details

I. General information

NPI: 1649548983
Provider Name (Legal Business Name): MEDIC TRANSPORT AGENCY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C22 HACIENDA ANITA URB SANTA MARIA
GUAYANILLA PR
00656-1506
US

IV. Provider business mailing address

URB. SANTA MARIA CALLE-24 C-22
GUAYANILLA PR
00656
US

V. Phone/Fax

Practice location:
  • Phone: 787-394-8464
  • Fax:
Mailing address:
  • Phone: 787-394-8464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number1407900
License Number StatePR

VIII. Authorized Official

Name: PROF. HUMBERTO IRIZARRY
Title or Position: PRESIDENT
Credential: EMS
Phone: 787-394-8464