Provider Demographics
NPI:1861744682
Name:JL AMBULANCE SERVICE
Entity type:Organization
Organization Name:JL AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOPEZ SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-607-4638
Mailing Address - Street 1:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:RIO BLANCO
Mailing Address - State:PR
Mailing Address - Zip Code:00744-0374
Mailing Address - Country:US
Mailing Address - Phone:787-607-4638
Mailing Address - Fax:787-465-0586
Practice Address - Street 1:BO PENA POBRE CUESTA EL PILON
Practice Address - Street 2:
Practice Address - City:NAGUABO
Practice Address - State:PR
Practice Address - Zip Code:00718-0301
Practice Address - Country:US
Practice Address - Phone:787-607-4638
Practice Address - Fax:787-465-0586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001425341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherNONE