# MEDIC LIFE SUPPORT LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184308207
- **Authorized official:** WASLEY RESTO COLON (PRESIDENT)
- **Authorized official phone:** (787) 210-1400

## Contact information

- **Practice address:** CARR 14 KM 13.2 URB ORTA LOCAL NUM 5, JUANA DIAZ, PR 00795
- **Practice address phone:** (787) 210-1400
- **Practice address fax:** (787) 936-7428
- **Mailing address:** 139 CALLE B, URB LA VEGA, VILLALBA, PR 00766
- **Mailing address phone:** (787) 210-1400

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | — | NULL | Yes |

## Other

- **Enumeration date:** 06/09/2023
- **Last updated:** 06/09/2023