Provider Demographics
NPI:1912168634
Name:ONE LIFE TRANSPORT CORP.
Entity Type:Organization
Organization Name:ONE LIFE TRANSPORT CORP.
Other - Org Name:ONE LIFE TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOBREN
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:787-533-2000
Mailing Address - Street 1:405 AVE ESMERALDA STE 102
Mailing Address - Street 2:PMB #323
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4466
Mailing Address - Country:US
Mailing Address - Phone:787-533-2000
Mailing Address - Fax:
Practice Address - Street 1:D10 CALLE 3
Practice Address - Street 2:URB TERRANOVA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5429
Practice Address - Country:US
Practice Address - Phone:787-533-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)