Provider Demographics
NPI:1235171695
Name:WENCHY AMBULANCE
Entity Type:Organization
Organization Name:WENCHY AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:OBET
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ- ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-262-8526
Mailing Address - Street 1:P.O. BOX 850
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-0850
Mailing Address - Country:US
Mailing Address - Phone:787-262-8526
Mailing Address - Fax:
Practice Address - Street 1:CARR. 119 KM. 9.2 BO. CAMUY ARRIBA
Practice Address - Street 2:PALOMAR PLAZA SUITE 2
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627
Practice Address - Country:US
Practice Address - Phone:787-262-8526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC-AMB-203341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0057383Medicare PIN