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General NPI Number Information
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NPI Number | 1124354923
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Entity Type | Organization
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Legal Business Name | PRIMARY LIFE SUPPORT CORP.
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Dates
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Enumeration Date | 10/29/2009
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Last Update Date | 10/29/2009
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Provider Practice Location Address
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Address Line | CARR 4417 KM 0.6 INTERIOR BO MAMEY
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City | AGUADA
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State | PR
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Zip | 00602
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Country | US
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Telephone | 787-629-9973
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Fax |
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Provider Business Mailing Address
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Address Line | P O BOX 1291
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City | AGUADA
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State | PR
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Zip | 00602
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Country | US
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Telephone | 787-629-9973
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Fax |
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Authorized Official
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Title or Position | PRESIDENTE
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Name | JOEL AROCHO MOLINA
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Credential |
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Telephone | 787-629-9973
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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 | CP-4739
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License Number State | PR
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