1699906958 NPI number — CARRILLO AMBULANCE CORP

Table of content: (NPI 1699906958)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699906958 NPI number — CARRILLO AMBULANCE CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARRILLO AMBULANCE CORP
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:
1699906958
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
AVE LOS PATRIOTAS CARR 111
Provider Second Line Business Mailing Address:
KM 2.9
Provider Business Mailing Address City Name:
LARES
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00669-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-897-1444
Provider Business Mailing Address Fax Number:
787-544-1377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE LOS PATRIOTAS CARR 111
Provider Second Line Business Practice Location Address:
KM 2.9
Provider Business Practice Location Address City Name:
LARES
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00669-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-897-1444
Provider Business Practice Location Address Fax Number:
787-544-1377
Provider Enumeration Date:
08/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SOSA
Authorized Official First Name:
ISMAEL
Authorized Official Middle Name:
CORDERO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-897-1444

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  TCAMB 613 , 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: TCAMB 613 . This is a "LIC COMISION" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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