=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508519497
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASTACIO MEDICAL SYSTEM CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2022
-----------------------------------------------------
Last Update Date | 02/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | BO COLLORES SOLAR 9 CARR 926 KM 3.2
-----------------------------------------------------
City | HUMACAO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00791
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-955-3360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | RR 6 BOX 10992
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00926-9479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-955-3360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENTE
-----------------------------------------------------
Name | CARLOS ASTACIO CASTRO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-955-3360
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------