Provider Demographics
NPI:1245480953
Name:ALICEA, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:ALICEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMBULANCIAS
Other - Middle Name:
Other - Last Name:DEL CENTRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:RR 4 BOX 4861
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-9251
Mailing Address - Country:US
Mailing Address - Phone:787-371-9490
Mailing Address - Fax:787-739-3324
Practice Address - Street 1:RR 4 BOX 4861
Practice Address - Street 2:BO SUD ARRIBA SECTOR GLEZ CARR 171 KM0.9 INT
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-9251
Practice Address - Country:US
Practice Address - Phone:787-371-9490
Practice Address - Fax:787-739-3324
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC-AMB-553146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0092607Medicare UPIN