=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316987696
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARTA I MORALES FEBLES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2006
-----------------------------------------------------
Last Update Date | 09/21/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CALLE K NUEVA VIDA EL TUQUE R8
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-647-0069
-----------------------------------------------------
Fax | 787-841-5840
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | CALLE NUEVA VIDA EL TUQUE R8
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-647-0069
-----------------------------------------------------
Fax | 787-841-5840
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MISS MARTA MORALES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-647-0069
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------