=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518973387
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PABLO ROSARIO SR. AMBULANCE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CALLE MIRAFLORES 36
-----------------------------------------------------
City | JUNCOS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00777-2708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-734-0474
-----------------------------------------------------
Fax | 787-734-0777
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2708 CALLE MIRAFLORES 36
-----------------------------------------------------
City | JUNCOS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00777-2708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-734-0474
-----------------------------------------------------
Fax | 787-734-0777
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | TC AMB 163
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------