Healthcare Provider Details

I. General information

NPI: 1487312542
Provider Name (Legal Business Name): VITAL CARE AMBULANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 07/24/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ANDALUCIA EDIF 401 OFICINA AN3
SAN JUAN PR
00922-0998
US

IV. Provider business mailing address

URB PUERTO NUEVO 362 PMB 203 AVE ANDALUCIA
SAN JUAN PR
00920-4103
US

V. Phone/Fax

Practice location:
  • Phone: 787-438-8885
  • Fax:
Mailing address:
  • Phone: 787-423-8885
  • 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: GLORIAN CORDOVA
Title or Position: PRESIDENTE
Credential:
Phone: 787-529-4504