Healthcare Provider Details

I. General information

NPI: 1902925969
Provider Name (Legal Business Name): GUADAMED AMBULANCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 2 BOX 12142
GURABO PR
00778-9613
US

IV. Provider business mailing address

HC 2 BOX 12142
GURABO PR
00778-9613
US

V. Phone/Fax

Practice location:
  • Phone: 787-949-3177
  • Fax: 787-737-7603
Mailing address:
  • Phone: 787-949-3177
  • Fax: 787-737-7603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number4126280
License Number StatePR

VIII. Authorized Official

Name: MRS. REBECA I VEGA DIAZ
Title or Position: ADMINISTRADORA
Credential:
Phone: 787-949-3177