=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376249524
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DYNASTY EMERGENCY MEDICAL SERVICE CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2023
-----------------------------------------------------
Last Update Date | 01/31/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | URBANIZACION INTERAMERICANA CALLE 15 AD13
-----------------------------------------------------
City | TRUJILLO ALTO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00976-3407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-481-7592
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 280
-----------------------------------------------------
City | TRUJILLO ALTO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00977-0280
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-874-8175
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JAVIER J RIVERA MOLINA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-481-7592
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------