Healthcare Provider Details

I. General information

NPI: 1770142812
Provider Name (Legal Business Name): CMC AMBULANCE & NON EMERGENCY TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 848 KM 0.7 EDIFICIO 3 OFICINA 203 BO SAINT JUST
TRUJILLO ALTO PR
00978
US

IV. Provider business mailing address

PO BOX 810061
CAROLINA PR
00981-0061
US

V. Phone/Fax

Practice location:
  • Phone: 787-550-6218
  • Fax:
Mailing address:
  • Phone: 787-983-7961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: MR. BRENDALIZ RODRIGUEZ
Title or Position: PRESIDENT
Credential:
Phone: 787-983-7961