Provider Demographics
NPI:1720196017
Name:ANGEL GONZALEZ PEREZ
Entity Type:Organization
Organization Name:ANGEL GONZALEZ PEREZ
Other - Org Name:ANGEL L. GONZALEZ
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:787-530-8953
Mailing Address - Street 1:PO BOX 1438
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-1438
Mailing Address - Country:US
Mailing Address - Phone:787-530-8953
Mailing Address - Fax:787-818-1122
Practice Address - Street 1:CARR. 110 KM12.8
Practice Address - Street 2:BO. PUEBLO
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-530-8953
Practice Address - Fax:787-818-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC-AMB-1013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR59253Medicare PIN