Healthcare Provider Details

I. General information

NPI: 1457078602
Provider Name (Legal Business Name): VITALIFE AMBULANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 A AVENIDA AMERICO MIRANDA
SAN JUAN PR
00921-1650
US

IV. Provider business mailing address

PO BOX 193596
SAN JUAN PR
00919-3596
US

V. Phone/Fax

Practice location:
  • Phone: 787-932-7771
  • Fax:
Mailing address:
  • Phone: 787-932-7771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ADA J RIVERA MACHADO
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 787-932-7771