Provider Demographics
NPI:1255348850
Name:MUNICIPIO AUTONOMO DE GUAYNABO
Entity type:Organization
Organization Name:MUNICIPIO AUTONOMO DE GUAYNABO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-720-4040
Mailing Address - Street 1:PO BOX 7885
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-7885
Mailing Address - Country:US
Mailing Address - Phone:787-720-4040
Mailing Address - Fax:787-272-1582
Practice Address - Street 1:BARRIO FRAILES LLANO, EDIFICIO SANTOS RIVERA PEREZ
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00970
Practice Address - Country:US
Practice Address - Phone:787-720-8033
Practice Address - Fax:787-272-1582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC294341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherEIN
PR5-5297Medicare ID - Type UnspecifiedAMBULANCE