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General NPI Number Information
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NPI Number | 1801035563
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Entity Type | Organization
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Legal Business Name | CARIBBEAN LIFE SUPPORT TRANSPORT CORP
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Dates
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Enumeration Date | 02/19/2009
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Last Update Date | 02/19/2009
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Provider Practice Location Address
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Address Line | CARRETERA 110 KM 21.1 BO. CEIBA BAJA
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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 | 787-903-1658
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Fax |
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Provider Business Mailing Address
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Address Line | URB VISTA VERDE 714 CALLE 16
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City | AGUADILLA
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State | PR
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Zip | 00603
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Country | US
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Telephone | 787-903-1658
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KERMITT S MORALES
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Credential |
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Telephone | 787-903-1658
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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 560
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License Number State | PR
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