Provider Demographics
NPI:1649220070
Name:WILFREDO COLLAZO FERNANDEZ
Entity Type:Organization
Organization Name:WILFREDO COLLAZO FERNANDEZ
Other - Org Name:AMANDA AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLAZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-824-2322
Mailing Address - Street 1:HC 1 BOX 6634
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:PR
Mailing Address - Zip Code:00751-9737
Mailing Address - Country:US
Mailing Address - Phone:787-824-2322
Mailing Address - Fax:
Practice Address - Street 1:CALLE 111 LA PLENA
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751
Practice Address - Country:US
Practice Address - Phone:787-824-2322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC AMB 2413416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0053080Medicare ID - Type UnspecifiedAMBULANCE LAND