Provider Demographics
NPI:1689604670
Name:FRANK RIVERA
Entity Type:Organization
Organization Name:FRANK RIVERA
Other - Org Name:BLUE STAR AMBULANCE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROPIETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:TEM
Authorized Official - Phone:787-828-2424
Mailing Address - Street 1:CARRETERA 140 KM 8.5 BARRIO COLLORES
Mailing Address - Street 2:P.O. BOX 1233
Mailing Address - City:JAYUYA
Mailing Address - State:PR
Mailing Address - Zip Code:00664-1233
Mailing Address - Country:US
Mailing Address - Phone:787-828-2424
Mailing Address - Fax:787-828-2424
Practice Address - Street 1:CARRETERA 140 KM 8.5 BARRIO COLLORES
Practice Address - Street 2:
Practice Address - City:JAYUYA
Practice Address - State:PR
Practice Address - Zip Code:00664-1233
Practice Address - Country:US
Practice Address - Phone:787-828-2424
Practice Address - Fax:787-828-2424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB 1623416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0059341Medicare ID - Type UnspecifiedAMBULANCE SERVICES