Provider Demographics
NPI:1982182689
Name:MEDICAL AMBULETTE TRANSPORT CORP
Entity Type:Organization
Organization Name:MEDICAL AMBULETTE TRANSPORT CORP
Other - Org Name:CITAEXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:GERALDO
Authorized Official - Last Name:TEJEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-527-0909
Mailing Address - Street 1:5 CALLE NACAR
Mailing Address - Street 2:URB MIRABELLA VILLAGE
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-786-8600
Mailing Address - Fax:
Practice Address - Street 1:5 CALLE NACAR
Practice Address - Street 2:URB MIRABELLA VILLAGE
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-786-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRPCVTI-4773343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)