Provider Demographics
NPI:1821512070
Name:OLIVER AMBULANCE L L C
Entity Type:Organization
Organization Name:OLIVER AMBULANCE L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:OLIVERAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-453-6012
Mailing Address - Street 1:PO BOX 598
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-0598
Mailing Address - Country:US
Mailing Address - Phone:787-453-6012
Mailing Address - Fax:
Practice Address - Street 1:CALLE B E-13
Practice Address - Street 2:URB EL ROSARIO 2
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-453-6012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-31
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========Medicaid