Provider Demographics
NPI:1790106029
Name:DIANA LOPEZ SOBA
Entity Type:Organization
Organization Name:DIANA LOPEZ SOBA
Other - Org Name:ISLA AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-530-2364
Mailing Address - Street 1:PO BOX 1243
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1243
Mailing Address - Country:US
Mailing Address - Phone:787-530-2364
Mailing Address - Fax:
Practice Address - Street 1:13 REPARTO FELICIANO
Practice Address - Street 2:APTO 1A
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00681
Practice Address - Country:US
Practice Address - Phone:787-530-2364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB-4463416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRTCAMB-446OtherCSP AMBULANCE CERTIFICATION