Provider Demographics
NPI:1063075943
Name:VITALINE AMBULANCE LLC
Entity type:Organization
Organization Name:VITALINE AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDETE
Authorized Official - Prefix:MISS
Authorized Official - First Name:ADA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIVERA MACHADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:969-645-6730
Mailing Address - Street 1:PO BOX 193596
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-3596
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BO CAIMITO CAMINO FIGUEROA
Practice Address - Street 2:CARR 842 KM 1.2
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:939-645-6730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-17
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1Medicaid