Provider Demographics
NPI:1548203789
Name:ANGEL L DIAZ O'FARRILL DBA O'FARRILL AMBULANCE
Entity Type:Organization
Organization Name:ANGEL L DIAZ O'FARRILL DBA O'FARRILL AMBULANCE
Other - Org Name:ANGEL L DIAZ O'FARRILL DBA O'FARRILL AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-310-3860
Mailing Address - Street 1:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-0208
Mailing Address - Country:US
Mailing Address - Phone:787-310-3860
Mailing Address - Fax:787-292-3912
Practice Address - Street 1:CARR 176 KM 11 HM 2
Practice Address - Street 2:CAMINO RAMAL LOS GUAYABOS
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-310-3860
Practice Address - Fax:787-292-3912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB3453416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0056979Medicare ID - Type UnspecifiedAMBULANCE SERVICES