Provider Demographics
NPI:1356398374
Name:V.I.P. AMBULANCE CORPORATION
Entity type:Organization
Organization Name:V.I.P. AMBULANCE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-708-4558
Mailing Address - Street 1:PO BOX 29004
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0004
Mailing Address - Country:US
Mailing Address - Phone:787-708-4558
Mailing Address - Fax:787-790-9212
Practice Address - Street 1:180 CALLE JOSE F DIAZ
Practice Address - Street 2:APTO 1502 COND MONTE BRISAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5972
Practice Address - Country:US
Practice Address - Phone:787-708-4558
Practice Address - Fax:787-731-2711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB3133416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR50219OtherPREFERED MEDICARE CHOICE
PR890430OtherMEDICARE Y MUCHO MAS
PR0056620Other0056620
PR9004246OtherACAA
PA0056620Medicare ID - Type UnspecifiedMEDICARE