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General NPI Number Information
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NPI Number | 1295753457
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Entity Type | Organization
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Legal Business Name | JUAN A SIERRA VEGA
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 08/31/2007
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Provider Practice Location Address
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Address Line | CARR 110 KM 20.0 BO CENTRO
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City | MOCA
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State | PR
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Zip | 00676
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Country | US
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Telephone | 787-448-3153
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1777
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City | ISABELA
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State | PR
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Zip | 00662-1777
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Country | US
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Telephone | 787-448-3153
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUAN A SIERRA VEGA
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Credential |
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Telephone | 787-448-3153
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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 402
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License Number State | PR
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