Provider Demographics
NPI:1174264170
Name:GLORIA AMBULANCE LLC
Entity Type:Organization
Organization Name:GLORIA AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORAN GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-595-6655
Mailing Address - Street 1:PO BOX 1398
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-1398
Mailing Address - Country:US
Mailing Address - Phone:787-595-6655
Mailing Address - Fax:
Practice Address - Street 1:BO LIRIOS CARR 929 KM 0.3
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777
Practice Address - Country:US
Practice Address - Phone:787-923-1788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No341600000XTransportation ServicesAmbulance
No347C00000XTransportation ServicesPrivate Vehicle