Provider Demographics
NPI:1184154718
Name:LEONELAND ETTIENNE MEDICAL RESPONSE
Entity type:Organization
Organization Name:LEONELAND ETTIENNE MEDICAL RESPONSE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ETTIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-324-5401
Mailing Address - Street 1:PO BOX 320
Mailing Address - Street 2:
Mailing Address - City:CASTANER
Mailing Address - State:PR
Mailing Address - Zip Code:00631-0320
Mailing Address - Country:US
Mailing Address - Phone:787-324-5401
Mailing Address - Fax:787-563-5425
Practice Address - Street 1:CARRETERA 129 KM 24.1 BO PILETAS
Practice Address - Street 2:
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-0819
Practice Address - Country:US
Practice Address - Phone:787-718-9709
Practice Address - Fax:787-563-5425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB-740341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRTCAMB740OtherCOMICION SERVICIOS PUBLICOS