Healthcare Provider Details

I. General information

NPI: 1285966648
Provider Name (Legal Business Name): MMA TRANSMEDIC AMBULANCE SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 12/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 CALLE VINYATER URB COUNTRY CLUB
SAN JUAN PR
00924
US

IV. Provider business mailing address

PMB 547 P.O. BOX 6017
CAROLINA PR
00984-6017
US

V. Phone/Fax

Practice location:
  • Phone: 787-420-3778
  • Fax: 787-761-0911
Mailing address:
  • Phone: 787-420-3778
  • Fax: 787-761-0911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberTC-AMB-633
License Number StatePR

VIII. Authorized Official

Name: MR. JOSE A GAUTIER
Title or Position: DIRECTOR
Credential: EMT-P, FP-C, CCEMT-P
Phone: 787-420-3778