Provider Demographics
NPI:1932327434
Name:CARLOS RUIZ
Entity Type:Organization
Organization Name:CARLOS RUIZ
Other - Org Name:SAN RAFAEL AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-379-3224
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-1300
Mailing Address - Country:US
Mailing Address - Phone:787-379-3224
Mailing Address - Fax:787-882-8521
Practice Address - Street 1:RD 485 INT 4485 KM 3.0
Practice Address - Street 2:BO SAN JOSE
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678
Practice Address - Country:US
Practice Address - Phone:787-379-3224
Practice Address - Fax:787-882-8521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRB0793416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0059344Medicare ID - Type UnspecifiedMEDICARE