=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174916944
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH AMBULANCE LIFE CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2015
-----------------------------------------------------
Last Update Date | 03/18/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR 1 KM 88 SECTOR GODREAU LOTE 2
-----------------------------------------------------
City | SALINAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-824-4919
-----------------------------------------------------
Fax | 787-824-4176
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 89
-----------------------------------------------------
City | SALINAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00751-0089
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-316-7357
-----------------------------------------------------
Fax | 787-824-4176
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENTA
-----------------------------------------------------
Name | ROSA I ORTIZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-316-7357
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 758
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------