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General NPI Number Information
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NPI Number | 1407874050
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Entity Type | Organization
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Legal Business Name | LUCIANO ROMAN GONZALEZ
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | CARR #2 KM. 95.3 BO. YEGUADA
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City | CAMUY
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State | PR
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Zip | 00627
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Country | US
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Telephone | 787-898-4442
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Fax | 787-898-4442
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Provider Business Mailing Address
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Address Line | PO BOX 458
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City | QUEBRADILLAS
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State | PR
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Zip | 00678-0458
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Country | US
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Telephone | 787-898-4442
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Fax | 787-898-4442
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Authorized Official
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Title or Position | OWNER-ADMINISTRATOR
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Name | MR. LUCIANO ROMAN
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Credential |
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Telephone | 787-898-4442
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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 | TCAMB334
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License Number State | PR
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