Provider Demographics
NPI:1871756056
Name:RICHIEZ, EDGARDO R (TEM)
Entity type:Individual
Prefix:
First Name:EDGARDO
Middle Name:R
Last Name:RICHIEZ
Suffix:
Gender:M
Credentials:TEM
Other - Prefix:
Other - First Name:RICHIEZ
Other - Middle Name:AMBULANCE
Other - Last Name:SERVICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3020
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-3020
Mailing Address - Country:US
Mailing Address - Phone:787-856-3713
Mailing Address - Fax:
Practice Address - Street 1:BARRIADA LLUBERAS EL PARALELO CARR 376 KM 2
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698
Practice Address - Country:US
Practice Address - Phone:787-856-3713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRP690146L00000X
PRTCAMB1043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No3416L0300XTransportation ServicesAmbulanceLand Transport