=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891922456
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VARGAS AMBULANCE SERVICE, CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2009
-----------------------------------------------------
Last Update Date | 06/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6A COL LA PROVIDENCIA SECTOR GODREAU
-----------------------------------------------------
City | SALINAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00751-0000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-366-7279
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | BUZON 263 150A MARLIN ST MONTESORIA II
-----------------------------------------------------
City | AGUIRRE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00704-0000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-366-7279
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACCOUNTANT
-----------------------------------------------------
Name | MRS. SHARON IVETTE TORRES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-366-7279
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | TC AMB-576
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------