Healthcare Provider Details

I. General information

NPI: 1174573364
Provider Name (Legal Business Name): WILFREDO RAMOS NIEVES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CALLE SOCORRO
QUEBRADILLAS PR
00678-1814
US

IV. Provider business mailing address

PO BOX 1203
QUEBRADILLAS PR
00678-1203
US

V. Phone/Fax

Practice location:
  • Phone: 787-895-4453
  • Fax:
Mailing address:
  • Phone: 787-895-4453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberTC AMB 60
License Number StatePR

VIII. Authorized Official

Name: WILFREDO RAMOS
Title or Position: OWNER
Credential:
Phone: 787-895-4453