Provider Demographics
NPI:1699207837
Name:LIFE SUPPORT AMBULANCES SA DE CV
Entity Type:Organization
Organization Name:LIFE SUPPORT AMBULANCES SA DE CV
Other - Org Name:LIFE MEX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIETA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMACHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-526-9751
Mailing Address - Street 1:1500 CORDOVA RD STE 314
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2191
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BLVD LUIS DONALDO COLOSIO MZ6 LT5 LOC 1 SM306
Practice Address - Street 2:
Practice Address - City:CANCUN
Practice Address - State:QUINTANA ROO
Practice Address - Zip Code:77560
Practice Address - Country:MX
Practice Address - Phone:954-526-9751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
No3416S0300XTransportation ServicesAmbulanceWater Transport