Provider Demographics
NPI:1659864452
Name:PEREZ AMBULANCE
Entity Type:Organization
Organization Name:PEREZ AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWN
Authorized Official - Prefix:
Authorized Official - First Name:LIARA
Authorized Official - Middle Name:MABEL
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-718-5352
Mailing Address - Street 1:AA 16 CALLE 12
Mailing Address - Street 2:4TA SECC VILLA DEL REY
Mailing Address - City:CAGUAS
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00727
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AA 16 CALLE 12
Practice Address - Street 2:4TA SECC VILLA DEL REY
Practice Address - City:CAGUAS
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00727
Practice Address - Country:UM
Practice Address - Phone:787-718-5352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========Medicaid