=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174325153
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IGLESIAS MEDICAL SERVICE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2025
-----------------------------------------------------
Last Update Date | 03/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1034 CALLE COBANA NEGRA # B20
-----------------------------------------------------
City | CABO ROJO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00623-3816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 939-525-5964
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1034 CALLE COBANA NEGRA # B20
-----------------------------------------------------
City | CABO ROJO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00623-3816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 939-525-5964
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CRISTIAN J IGLESIAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 939-525-5964
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------