Provider Demographics
NPI:1184211435
Name:AV TECH AMBULANCE CORP.
Entity Type:Organization
Organization Name:AV TECH AMBULANCE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROSARIO SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-640-8177
Mailing Address - Street 1:HC 9 BOX 10555
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-9917
Mailing Address - Country:US
Mailing Address - Phone:939-366-6342
Mailing Address - Fax:
Practice Address - Street 1:17 PASEOS DE ALTA VISTA
Practice Address - Street 2:BO CAMASEYES
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:939-366-6342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-21
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1Medicaid