Healthcare Provider Details

I. General information

NPI: 1427882844
Provider Name (Legal Business Name): TACTICAL MEDIC RESPOND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 08/28/2024
Certification Date: 08/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 111 KM 6.4 BO PUEBLO MOCA
MOCA PR
00676
US

IV. Provider business mailing address

PO BOX 851
MOCA PR
00676-0851
US

V. Phone/Fax

Practice location:
  • Phone: 787-233-9648
  • Fax:
Mailing address:
  • Phone: 787-233-9648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MRS. YANITZA JIMENEZ MEDINA
Title or Position: PRESIDENT
Credential:
Phone: 787-233-9648