Provider Demographics
NPI:1841522208
Name:LIFE SHIELD AMBULANCE INC.
Entity type:Organization
Organization Name:LIFE SHIELD AMBULANCE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRUNILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEZ STELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-698-2506
Mailing Address - Street 1:406 AVE SAN CLAUDIO
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4117
Mailing Address - Country:US
Mailing Address - Phone:787-698-2506
Mailing Address - Fax:
Practice Address - Street 1:406 AVE SAN CLAUDIO
Practice Address - Street 2:SUITE 7
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4117
Practice Address - Country:US
Practice Address - Phone:787-698-2506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC - AMB 6373416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport