Provider Demographics
NPI:1699906958
Name:CARRILLO AMBULANCE CORP
Entity type:Organization
Organization Name:CARRILLO AMBULANCE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISMAEL
Authorized Official - Middle Name:CORDERO
Authorized Official - Last Name:SOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-897-1444
Mailing Address - Street 1:AVE LOS PATRIOTAS CARR 111
Mailing Address - Street 2:KM 2.9
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-0001
Mailing Address - Country:US
Mailing Address - Phone:787-897-1444
Mailing Address - Fax:787-544-1377
Practice Address - Street 1:AVE LOS PATRIOTAS CARR 111
Practice Address - Street 2:KM 2.9
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-0001
Practice Address - Country:US
Practice Address - Phone:787-897-1444
Practice Address - Fax:787-544-1377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB 613341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRTCAMB 613OtherLIC COMISION