Provider Demographics
NPI:1174705461
Name:SAN RAFAEL AMBULANCE CORP
Entity type:Organization
Organization Name:SAN RAFAEL AMBULANCE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GARCIA HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-379-3224
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-1300
Mailing Address - Country:US
Mailing Address - Phone:787-379-3224
Mailing Address - Fax:787-818-0429
Practice Address - Street 1:88B AVE MONTEMAR
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5567
Practice Address - Country:US
Practice Address - Phone:787-379-3224
Practice Address - Fax:787-818-0429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB 5083416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0059490Medicare PIN