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General NPI Number Information
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NPI Number | 1699759639
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Entity Type | Organization
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Legal Business Name | PROMEDIC AMBULANCE SERVICE
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Dates
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Enumeration Date | 12/02/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 411 SOLDADO ALCIDES REYES ST. SAN AGUSTIN
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City | SAN JUAN
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State | PR
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Zip | 00928
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Country | US
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Telephone | 787-764-4882
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Fax | 787-754-7864
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Provider Business Mailing Address
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Address Line | 411 SOLDADO ALCIDES REYES ST. SAN AGUSTIN
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City | SAN JUAN
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State | PR
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Zip | 00928
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Country | US
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Telephone | 787-764-4882
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Fax | 787-754-7864
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. VELAZQUEZ EDGARDO
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Credential |
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Telephone | 787-764-4882
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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 |
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License Number State | PR
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