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General NPI Number Information
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NPI Number | 1720196017
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Entity Type | Organization
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Legal Business Name | ANGEL GONZALEZ PEREZ
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Dates
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Enumeration Date | 08/27/2006
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | CARR. 110 KM12.8 BO. PUEBLO
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City | MOCA
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State | PR
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Zip | 00676
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Country | US
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Telephone | 787-530-8953
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Fax | 787-818-1122
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Provider Business Mailing Address
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Address Line | PO BOX 1438
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City | MOCA
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State | PR
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Zip | 00676-1438
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Country | US
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Telephone | 787-530-8953
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Fax | 787-818-1122
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Authorized Official
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Title or Position | OWNER
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Name | MR. ANGEL LUIS GONZALEZ
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Credential | EMT
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Telephone | 787-530-8953
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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 | TC-AMB-101
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License Number State | PR
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