Provider Demographics
NPI:1720243314
Name:YOUR LIFE AMBULANCE, CORP
Entity Type:Organization
Organization Name:YOUR LIFE AMBULANCE, CORP
Other - Org Name:YOUR LIFE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:ELEXS
Authorized Official - Middle Name:RUIZ
Authorized Official - Last Name:ARJEMI
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:787-292-9922
Mailing Address - Street 1:CALLE 2 ALTURAS DE RIO GRANDE
Mailing Address - Street 2:B-89
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745
Mailing Address - Country:UM
Mailing Address - Phone:292-9922
Mailing Address - Fax:
Practice Address - Street 1:CALLE 2 ALTURAS DE RIO GRANDE
Practice Address - Street 2:B-89
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-292-9922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUR LIFE AMBULANCE, CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4051734341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherNPI