Provider Demographics
NPI:1578175881
Name:VICTORIAS ADVANCED LIFE SUPPORT CORP
Entity Type:Organization
Organization Name:VICTORIAS ADVANCED LIFE SUPPORT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SANYET
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDICO
Authorized Official - Phone:787-222-6240
Mailing Address - Street 1:PO BOX 946
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-0946
Mailing Address - Country:US
Mailing Address - Phone:787-222-6240
Mailing Address - Fax:
Practice Address - Street 1:7 CALLE TEODOMIRO DELFAU
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-3246
Practice Address - Country:US
Practice Address - Phone:787-222-6240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport