Provider Demographics
NPI:1063657427
Name:MAF AMB SERVICES 1 CORP
Entity Type:Organization
Organization Name:MAF AMB SERVICES 1 CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:MAXIMO
Authorized Official - Middle Name:E
Authorized Official - Last Name:FAULKNER RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:TEMP
Authorized Official - Phone:939-639-6697
Mailing Address - Street 1:PO BOX 141661
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-1661
Mailing Address - Country:US
Mailing Address - Phone:787-639-6697
Mailing Address - Fax:787-650-4296
Practice Address - Street 1:54 CALLE 14
Practice Address - Street 2:URB VICTOR ROJAS II
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-3007
Practice Address - Country:US
Practice Address - Phone:939-639-6697
Practice Address - Fax:787-650-4296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC-AMB-563341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance