Provider Demographics
NPI:1790997617
Name:PABLO ROSARIO ORTIZ
Entity Type:Organization
Organization Name:PABLO ROSARIO ORTIZ
Other - Org Name:CORDOVA AMBULANCE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRADOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-734-0474
Mailing Address - Street 1:PO BOX 2708
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777
Mailing Address - Country:US
Mailing Address - Phone:787-734-0474
Mailing Address - Fax:787-734-0777
Practice Address - Street 1:CARRETERA 929 KM 1
Practice Address - Street 2:BO LIRIOS
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777
Practice Address - Country:US
Practice Address - Phone:787-734-0474
Practice Address - Fax:787-734-0777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB1633416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6107OtherAMERICAN HEALTH MEDICARE
PR8100028OtherHUMANA
PR9003134OtherACAA
PRPMCOther990295
PR890272OtherMEDICARE Y MUCHO MAS
PR=========OtherHUMANA GOLD PLUS
PR8100028OtherHUMANA
PR0059311Medicare PIN