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General NPI Number Information
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NPI Number | 1063508802
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Entity Type | Organization
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Legal Business Name | EBENEZER AMBULANCE INC.
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | AVE FERNANDEZ JUNCOS PTA DE TIERRA
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City | SAN JUAN
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State | PR
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Zip | 00906-5095
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Country | US
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Telephone | 787-721-7413
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9065095
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City | SAN JUAN
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State | PR
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Zip | 00906-5095
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Country | US
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Telephone | 787-721-7413
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Fax |
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Authorized Official
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Title or Position | PRESIDENTE
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Name | JOSE COLON MARRERO
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Credential |
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Telephone | 787-721-7413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | TC-AMB 420
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License Number State | PR
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