1427357862 NPI number — THE GOLDEN FENNIX AMBULANCE SERVICE INC

Table of content: LAURA MARIE LAZENBY FNP (NPI 1356438667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427357862 NPI number — THE GOLDEN FENNIX AMBULANCE SERVICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE GOLDEN FENNIX AMBULANCE SERVICE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427357862
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 144100
Provider Second Line Business Mailing Address:
ARECIBO, PMB 160
Provider Business Mailing Address City Name:
ARECIBO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-452-4259
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BUENOS AIRES
Provider Second Line Business Practice Location Address:
CALLE JOSE OLMO 317
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-452-4259
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALVAREZ
Authorized Official First Name:
WILMA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENTE
Authorized Official Telephone Number:
787-452-4259

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  1951486 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)