Healthcare Provider Details

I. General information

NPI: 1174264170
Provider Name (Legal Business Name): GLORIA AMBULANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO LIRIOS CARR 929 KM 0.3
JUNCOS PR
00777
US

IV. Provider business mailing address

PO BOX 1398
JUNCOS PR
00777-1398
US

V. Phone/Fax

Practice location:
  • Phone: 787-923-1788
  • Fax:
Mailing address:
  • Phone: 787-595-6655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. GUILLERMO D MORAN GOMEZ
Title or Position: PRESIDENT TREASURER
Credential:
Phone: 787-595-6655