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General NPI Number Information
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NPI Number | 1720227846
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Entity Type | Individual
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Provider Name | EDGARDO J JIRAU SOTO
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Gender | Male
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Dates
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Enumeration Date | 02/12/2009
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Last Update Date | 04/28/2009
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Provider Practice Location Address
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Address Line | CARR 111 INT 602 KM 0.1
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City | ANGELES
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State | PR
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Zip | 00611-0000
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Country | US
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Telephone | 787-933-6781
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Fax | 787-933-6781
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Provider Business Mailing Address
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Address Line | PO BOX 99
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City | ANGELES
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State | PR
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Zip | 00611-0099
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Country | US
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Telephone | 787-933-6781
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Fax | 787-933-6781
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | TC AMB 559
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License Number State | PR
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