Healthcare Provider Details

I. General information

NPI: 1023861010
Provider Name (Legal Business Name): MICAELA LIFE AMBULANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BLVD JIMMY TORRES
YAUCO PR
00698-2847
US

IV. Provider business mailing address

PO BOX 1081
PENUELAS PR
00624-1081
US

V. Phone/Fax

Practice location:
  • Phone: 787-718-7050
  • Fax:
Mailing address:
  • Phone: 787-718-7050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ROBERTO CRUZ
Title or Position: PRESIDENT
Credential:
Phone: 787-718-7050