Healthcare Provider Details

I. General information

NPI: 1376249524
Provider Name (Legal Business Name): DYNASTY EMERGENCY MEDICAL SERVICE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 01/31/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URBANIZACION INTERAMERICANA CALLE 15 AD13
TRUJILLO ALTO PR
00976-3407
US

IV. Provider business mailing address

PO BOX 280
TRUJILLO ALTO PR
00977-0280
US

V. Phone/Fax

Practice location:
  • Phone: 787-481-7592
  • Fax:
Mailing address:
  • Phone: 787-874-8175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MR. JAVIER J RIVERA MOLINA
Title or Position: PRESIDENT
Credential:
Phone: 787-481-7592