Healthcare Provider Details

I. General information

NPI: 1326271966
Provider Name (Legal Business Name): MEDIC SHUTTLE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 AVE ESCORIAL CAPARRA HEIGHTS
SAN JUAN PR
00920-4719
US

IV. Provider business mailing address

1353 AVE LUIS VIGOREAUX PMB 677
GUAYNABO PR
00966-2715
US

V. Phone/Fax

Practice location:
  • Phone: 787-599-5417
  • Fax: 787-273-7193
Mailing address:
  • Phone: 787-599-5417
  • Fax: 787-273-7193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHIRLEY ANN RIVERA
Title or Position: OWNER
Credential:
Phone: 787-599-5417