Provider Demographics
NPI:1417491366
Name:DAVIANN AMBULANCE INCORPORATED
Entity Type:Organization
Organization Name:DAVIANN AMBULANCE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARAMEDIC
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRASCO CARRASCO
Authorized Official - Suffix:
Authorized Official - Credentials:EMT PARAMEDIC
Authorized Official - Phone:787-451-0454
Mailing Address - Street 1:URB LA PROVIDENCIA CALLE 4 1A NUM 11
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:UM
Mailing Address - Phone:939-539-0059
Mailing Address - Fax:
Practice Address - Street 1:1A11 CALLE 4
Practice Address - Street 2:URB LA PROVIDENCIA
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:939-539-0059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR341600000X, 3416L0300X
PR387179341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport