=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538176664
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIORITY LIFE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CALLLE PARIS 243 PMB 1737
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-764-8319
-----------------------------------------------------
Fax | 787-767-0073
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | CALLE PARIS 159 BAJOS HATO REY
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-764-8319
-----------------------------------------------------
Fax | 787-767-0073
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRADOR
-----------------------------------------------------
Name | MRS. MIRIAM RESTREPO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-764-8319
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | TCAMB113
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------