Provider Demographics
NPI:1851694392
Name:SERGIO LOPEZ SOBA
Entity Type:Organization
Organization Name:SERGIO LOPEZ SOBA
Other - Org Name:SERGIO AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DUENO
Authorized Official - Prefix:MR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ SOBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-219-9207
Mailing Address - Street 1:5220 CALLE LORENCITA FERRER
Mailing Address - Street 2:EL TUQUE
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-4832
Mailing Address - Country:US
Mailing Address - Phone:787-219-9207
Mailing Address - Fax:
Practice Address - Street 1:COND TABAIBA GDNS
Practice Address - Street 2:AVE HUNGRIA 276
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-1384
Practice Address - Country:US
Practice Address - Phone:787-219-9207
Practice Address - Fax:787-843-0376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2677CP3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport