Provider Demographics
NPI:1285057711
Name:FIRST AMBULANCE PR
Entity type:Organization
Organization Name:FIRST AMBULANCE PR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:LOPEZ-COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-628-0115
Mailing Address - Street 1:105-220 WESTERN AUTO PLAZA
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-0000
Mailing Address - Country:US
Mailing Address - Phone:939-628-0115
Mailing Address - Fax:787-755-6560
Practice Address - Street 1:105-220 WESTERN AUTO PLAZA
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-0000
Practice Address - Country:US
Practice Address - Phone:939-628-0115
Practice Address - Fax:787-755-6560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1866341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance