Provider Demographics
NPI:1629084330
Name:GUTIERREZ AMBULANCE SERVICE
Entity Type:Organization
Organization Name:GUTIERREZ AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARIA
Authorized Official - Prefix:
Authorized Official - First Name:BURGOS
Authorized Official - Middle Name:E
Authorized Official - Last Name:DELIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-735-7129
Mailing Address - Street 1:CARR 7722 KM 5.6
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705
Mailing Address - Country:US
Mailing Address - Phone:787-735-7129
Mailing Address - Fax:787-735-1679
Practice Address - Street 1:CARR 7722 BO SIERRA
Practice Address - Street 2:
Practice Address - City:AIBINITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-735-7129
Practice Address - Fax:787-735-1679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2296304281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0050037Medicare ID - Type Unspecified