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General NPI Number Information
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NPI Number | 1700075777
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Entity Type | Organization
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Legal Business Name | SAN JOSE AMBULANCE SERVICE, INC.
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | CALLE 5 SOLAR 42 URB. CAMINO REAL
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City | CAGUAS
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State | PR
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Zip | 00727-0000
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Country | US
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Telephone | 787-286-3396
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Fax | 787-286-3396
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Provider Business Mailing Address
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Address Line | 12 URB CAMINO REAL
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City | CAGUAS
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State | PR
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Zip | 00727-7805
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Country | US
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Telephone | 787-286-3396
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Fax | 787-286-3396
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDWIN ORTIZ
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Credential | ACCOUNTANT
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Telephone | 787-286-3396
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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 | TCAMB-504
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License Number State | PR
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