Provider Demographics
NPI:1801845599
Name:OBDULIO SEGARRA VELEZ
Entity Type:Organization
Organization Name:OBDULIO SEGARRA VELEZ
Other - Org Name:SEGARRAS AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OBDULIO
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGARRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-896-0008
Mailing Address - Street 1:PO BOX 5077
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-5077
Mailing Address - Country:US
Mailing Address - Phone:787-896-0008
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 125 KM 18.6 INTERIOR
Practice Address - Street 2:BO POZAS
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-896-0008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC AMB 3363416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0056813Medicare PIN