Provider Demographics
NPI:1447921648
Name:VILLALBA MEDICAL TRANSPORT LLC
Entity type:Organization
Organization Name:VILLALBA MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-358-2362
Mailing Address - Street 1:URB LA VEGA
Mailing Address - Street 2:CALLE B 139
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766
Mailing Address - Country:US
Mailing Address - Phone:787-210-1400
Mailing Address - Fax:
Practice Address - Street 1:CARR 14 KM 13.2 URB ORTA LOCAL NUM 5
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-0079
Practice Address - Country:US
Practice Address - Phone:787-210-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRTCAMB-139362OtherCOMISION