Provider Demographics
NPI:1881645935
Name:RICARDO E BONILLA CORTES
Entity Type:Organization
Organization Name:RICARDO E BONILLA CORTES
Other - Org Name:JOSHUA PARAMEDIC AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:BONILLA CORTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-319-4609
Mailing Address - Street 1:HC 1 BOX 17340
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-9364
Mailing Address - Country:US
Mailing Address - Phone:787-319-4609
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 467 KM 1.6 INT
Practice Address - Street 2:BARRIO BORINQUEN
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-0000
Practice Address - Country:US
Practice Address - Phone:787-319-4609
Practice Address - Fax:787-551-7104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC AMB 3833416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR991236OtherPMC
PR999517OtherMMM
PR0057694Medicare PIN