=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629238654
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIREMEDIC AMBULANCE CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2008
-----------------------------------------------------
Last Update Date | 03/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR 3 AVE. 65 INFANTERIA KM 15.3
-----------------------------------------------------
City | CANOVANAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-514-3030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11 CALLE ARZUAGA R.P.M. #264 RIO PIEDRAS
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00925-3701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-514-3030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENTE
-----------------------------------------------------
Name | EFRAIN TORRES SR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-514-3030
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 146L00000X
-----------------------------------------------------
Taxonomy Name | Paramedic
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | TCAMB536
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------