Healthcare Provider Details

I. General information

NPI: 1679584122
Provider Name (Legal Business Name): RENAL CARE AMBULANCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. 65 INFANTERIA KM 2.0 OFFICE 22
SAN JUAN PR
00926-1910
US

IV. Provider business mailing address

PO BOX 194000 SUITE114
SAN JUAN PR
00919-4000
US

V. Phone/Fax

Practice location:
  • Phone: 787-754-8361
  • Fax:
Mailing address:
  • Phone: 787-751-1374
  • Fax: 787-767-4202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberTC-AMB-328
License Number StatePR

VIII. Authorized Official

Name: MRS. MARITZA A RODRIGUEZ
Title or Position: PRESIDENT
Credential:
Phone: 787-751-1374