Provider Demographics
NPI:1700825098
Name:MARANGELY SOLIVAN
Entity Type:Organization
Organization Name:MARANGELY SOLIVAN
Other - Org Name:JAM AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARANGELY
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-263-0914
Mailing Address - Street 1:PO BOX 372591
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-2591
Mailing Address - Country:US
Mailing Address - Phone:787-263-0914
Mailing Address - Fax:787-263-0914
Practice Address - Street 1:URB. LOS LAURELES
Practice Address - Street 2:CALLE ALMENDROS #13
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-263-0914
Practice Address - Fax:787-263-0914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0057105Medicare PIN