Provider Demographics
NPI:1689933632
Name:SANTIAGO BALBES, LUIS G
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:G
Last Name:SANTIAGO BALBES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PROLIFE
Other - Middle Name:AMBULANCE
Other - Last Name:SERVICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:URB HACIENDA CONCORDIA 11077
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-1077
Mailing Address - Country:US
Mailing Address - Phone:787-427-8374
Mailing Address - Fax:
Practice Address - Street 1:URB HACIENDA CONCORDIA 11077
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-1077
Practice Address - Country:US
Practice Address - Phone:787-427-8374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB 6913416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport