Provider Demographics
NPI:1629210745
Name:PROFESSIONAL HEALTHCARE AMBULANCE SERVICES, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL HEALTHCARE AMBULANCE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:GISMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-242-6871
Mailing Address - Street 1:HC 2 BOX 5871
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:PR
Mailing Address - Zip Code:00677-9533
Mailing Address - Country:US
Mailing Address - Phone:787-242-6871
Mailing Address - Fax:
Practice Address - Street 1:HC 2 BOX 5871
Practice Address - Street 2:CARR. 411 BO. CALVACHE
Practice Address - City:RINCON
Practice Address - State:PR
Practice Address - Zip Code:00677-9533
Practice Address - Country:US
Practice Address - Phone:787-242-6871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4448341341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance