MEDICARE: IMPERIUM AMBULANCE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance
2	341600000X	Ambulance

General Provider Information

NPI Number	:	1225853021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPERIUM AMBULANCE, LLC

Provider Business Mailing Address
First Line	:	572 COM CARACOLES 2
Second Line	:
City	:	PENUELAS
State	:	PR
Zip	:	00624-2558
Country	:	US
Telephone Number	:	787-400-6193
Fax Number	:

Provider Business Practice Location Address
First Line	:	953 INTERIOR CALLE MUNOZ RIVERA
Second Line	:
City	:	PENUELAS
State	:	PR
Zip	:	00624
Country	:	US
Telephone Number	:	787-400-6193
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENTE
Name	:	JAVIER SANTIAGO RODRIGUEZ
Credential	:
Telephone Number	:	787-400-6193

Provider Enumeration Date	:	11/18/2024
Last Update Date	:	05/27/2026

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Directions to “IMPERIUM AMBULANCE, LLC ” Practice Location

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