Organization
ILDEFONSO SANTIAGO AYALA
Active
Other names
MEDLIFE AMBULANCE
Organization subpart
No
Provider details
NPI number
Authorized official
ILDEFONSO SANTIAGO AYALA (OWNER)
(787) 255-0636
Entity
Organization
Contact information
Practice address
102 CALLE PARQUE W, MONTE GRANDE, CABO ROJO, PR 00623-3735
(787) 255-0636
Mailing address
PO BOX 1847, CABO ROJO, PR 00623-1847
(787) 255-0636
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
TC AMB 310
PR
Other
Enumeration date
05/06/2006
Last updated
01/18/2010
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