1205033404 NPI number — YARIE & OMAR AMBULANCE INC

Table of content: (NPI 1205033404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205033404 NPI number — YARIE & OMAR AMBULANCE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YARIE & OMAR AMBULANCE 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:
1205033404
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 819
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAYUYA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00664-0819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-828-3880
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERA 144 KM 2.8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAYUYA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-828-3880
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DE JESUS
Authorized Official First Name:
MIRELLA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-828-3880

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  TC AMB 474 , 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)

  • Identifier: TC AMB 474 . This is a "AMBULANCE LAND" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com