Provider Demographics
NPI:1093758815
Name:ANGEL G. ARCHILLA MONTES
Entity Type:Organization
Organization Name:ANGEL G. ARCHILLA MONTES
Other - Org Name:FIRST CARE AMBULANCE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:ARCHILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-615-1936
Mailing Address - Street 1:160 PIRINEO STREET
Mailing Address - Street 2:LAS CUMBRES
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-615-1936
Mailing Address - Fax:
Practice Address - Street 1:160 PIRINEO STREET
Practice Address - Street 2:LAS CUMBRES
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-615-1936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB-2893416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5-4815Medicare ID - Type Unspecified