=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275455362
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIUM AMBULANCE SERVICE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2026
-----------------------------------------------------
Last Update Date | 07/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 963 AVE HOSTOS
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00716-1103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 939-903-2216
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1081
-----------------------------------------------------
City | PENUELAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00624-1081
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 939-903-2216
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENTE
-----------------------------------------------------
Name | ROSALEEN PEREZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 939-903-2216
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------