Healthcare Provider Details

I. General information

NPI: 1104238252
Provider Name (Legal Business Name): LIFE SUPPORT AMBULANCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2014
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLVD. LUIS DONALDO COLOSIO MZ. 6 LOTE 5 SUPER MZ. 306
CANCUN QUINTANA ROO
77560
MX

IV. Provider business mailing address

1500 CORDOVA RD 314
FORT LAUDERDALE FL
33316-2115
US

V. Phone/Fax

Practice location:
  • Phone: 18663778443
  • Fax:
Mailing address:
  • Phone: 954-526-9751
  • Fax: 954-376-6163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DIXAN GONZALEZ
Title or Position: COO
Credential:
Phone: 954-526-9751