Provider Demographics
NPI:1194916148
Name:HATIMED AMBULANCE SERVICE CORP.
Entity type:Organization
Organization Name:HATIMED AMBULANCE SERVICE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SEPULVADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-356-8136
Mailing Address - Street 1:B1 CALLE MIGUEL GONZALEZ
Mailing Address - Street 2:HATILLO DEL MAR
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-2220
Mailing Address - Country:US
Mailing Address - Phone:787-566-6200
Mailing Address - Fax:787-820-5866
Practice Address - Street 1:905 AVE SAN LUIS
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-3834
Practice Address - Country:US
Practice Address - Phone:787-566-6200
Practice Address - Fax:787-820-5866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC AMB 5403416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport