Provider Demographics
NPI:1952669749
Name:VICTORIOUS CARE AMBULANCE SERVICE LLC
Entity Type:Organization
Organization Name:VICTORIOUS CARE AMBULANCE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-568-1178
Mailing Address - Street 1:4100 SAN BERNARDO AVE STE E6-A
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-4445
Mailing Address - Country:US
Mailing Address - Phone:956-568-1178
Mailing Address - Fax:956-568-1185
Practice Address - Street 1:4100 SAN BERNARDO AVE STE E6-A
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-4445
Practice Address - Country:US
Practice Address - Phone:956-568-1178
Practice Address - Fax:956-568-1185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10008133416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport