Healthcare Provider Details

I. General information

NPI: 1225853021
Provider Name (Legal Business Name): IMPERIUM AMBULANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

953 INTERIOR CALLE MUNOZ RIVERA
PENUELAS PR
00624
US

IV. Provider business mailing address

572 COM CARACOLES 2
PENUELAS PR
00624-2558
US

V. Phone/Fax

Practice location:
  • Phone: 787-400-6193
  • Fax:
Mailing address:
  • Phone: 787-400-6193
  • 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: JAVIER SANTIAGO RODRIGUEZ
Title or Position: PRESIDENTE
Credential:
Phone: 787-400-6193