Provider Demographics
NPI:1528192119
Name:ACTIVE AMBULANCE INC
Entity Type:Organization
Organization Name:ACTIVE AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:NICOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-448-0911
Mailing Address - Street 1:400 AVE. PENSILVANNIA
Mailing Address - Street 2:APARTADO # 406
Mailing Address - City:SALINAS
Mailing Address - State:PR
Mailing Address - Zip Code:00751-3247
Mailing Address - Country:US
Mailing Address - Phone:787-448-0911
Mailing Address - Fax:
Practice Address - Street 1:349 CALLE 15
Practice Address - Street 2:URB. LA ARBOLEDA
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751-3103
Practice Address - Country:US
Practice Address - Phone:787-448-0911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport