# ILDEFONSO SANTIAGO AYALA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MEDLIFE AMBULANCE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457300741
- **Authorized official:** ILDEFONSO SANTIAGO AYALA (OWNER)
- **Authorized official phone:** (787) 255-0636

## Contact information

- **Practice address:** 102 CALLE PARQUE W, MONTE GRANDE, CABO ROJO, PR 00623-3735
- **Practice address phone:** (787) 255-0636
- **Mailing address:** PO BOX 1847, CABO ROJO, PR 00623-1847
- **Mailing address phone:** (787) 255-0636

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | TC AMB 310 | PR | Yes |

## Other

- **Enumeration date:** 05/06/2006
- **Last updated:** 01/18/2010