Provider Demographics
NPI:1457599110
Name:PEDRO J NEVAREZ BRUNO
Entity Type:Organization
Organization Name:PEDRO J NEVAREZ BRUNO
Other - Org Name:NEVAREZ AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:NEVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-642-6272
Mailing Address - Street 1:PO BOX 3061
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-3061
Mailing Address - Country:US
Mailing Address - Phone:787-642-6272
Mailing Address - Fax:787-785-6097
Practice Address - Street 1:URB.CIBUCO
Practice Address - Street 2:CALLE 1 C-13
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-1341
Practice Address - Country:US
Practice Address - Phone:787-451-2727
Practice Address - Fax:787-785-6097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2013-04-11
Deactivation Date:2009-05-01
Deactivation Code:
Reactivation Date:2009-05-21
Provider Licenses
StateLicense IDTaxonomies
PRTC-AMB5753416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport