# PEACH STATE AMBULANCE OF PR INC

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

## Provider details

- **NPI number:** 1902127731
- **Authorized official:** MRS. YASMIN DE LACRUZ RUIZ (PRESIDENT)
- **Authorized official phone:** (787) 213-7522

## Contact information

- **Practice address:** CARR NUM 2 KM 97.7, BO COCOS, QUEBRADILLAS, PR 00678-9998
- **Practice address phone:** (787) 213-7522
- **Practice address fax:** (787) 551-7104
- **Mailing address:** 58 CALLE SOCORRO PMB 22, QUEBRADILLAS, PR 00678-1854
- **Mailing address phone:** (787) 213-7522
- **Mailing address fax:** (787) 895-8282

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | TCAMB 646 | PR | Yes |
| 343900000X | Non-emergency Medical Transport (VAN) | — | NULL | — |

## Other

- **Enumeration date:** 06/16/2010
- **Last updated:** 11/13/2025