Provider Demographics
NPI:1013067735
Name:CRUZ CARRANZA AMBULANCE SERVICE LLC
Entity Type:Organization
Organization Name:CRUZ CARRANZA AMBULANCE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-367-8158
Mailing Address - Street 1:PO BOX 2671
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78540-2671
Mailing Address - Country:US
Mailing Address - Phone:956-631-4898
Mailing Address - Fax:956-994-9332
Practice Address - Street 1:902 E BEECH AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2634
Practice Address - Country:US
Practice Address - Phone:956-631-4898
Practice Address - Fax:956-994-9332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108067341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB473OtherBLUE CROSS
TX168301301Medicaid
TXAMB407Medicare ID - Type Unspecified