Provider Demographics
NPI:1225141088
Name:PABLO A. GOMEZ
Entity Type:Organization
Organization Name:PABLO A. GOMEZ
Other - Org Name:MEDSTAR E.M.S.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:TEM
Authorized Official - Phone:787-891-6076
Mailing Address - Street 1:137 CALLE HARRISON
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-1503
Mailing Address - Country:US
Mailing Address - Phone:787-617-9110
Mailing Address - Fax:787-890-0724
Practice Address - Street 1:BO. CAMASEYES CARR. 467 KM 4.4 INT
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-1519
Practice Address - Country:US
Practice Address - Phone:787-617-9110
Practice Address - Fax:787-890-0724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC - AMB 4113416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherAMBULANCE