Provider Demographics
NPI:1902127731
Name:PEACH STATE AMBULANCE OF PR INC
Entity Type:Organization
Organization Name:PEACH STATE AMBULANCE OF PR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:YASMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LACRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-213-7522
Mailing Address - Street 1:CALLE SOCORRO 58 PMB 22
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678
Mailing Address - Country:US
Mailing Address - Phone:787-213-7522
Mailing Address - Fax:787-895-8282
Practice Address - Street 1:CARR NUM 2 KM 97.7
Practice Address - Street 2:BO COCOS
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678
Practice Address - Country:US
Practice Address - Phone:787-213-7522
Practice Address - Fax:787-551-7104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB 6463416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport