Medic Life Support LLC

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

Legal business name

MEDIC LIFE SUPPORT LLC

Practice address

Carr 14 KM 13.2 Urb Orta Local Num 5
Juana Diaz, PR 00795

Phone

(787) 210-1400

Fax

(787) 936-7428

NPI assigned

Jun 9, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Wasley Resto Colon

Title

President

Phone

(787) 210-1400

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PR

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686268800000",
    "number": "1184308207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 CALLE B",
            "address_2": "URB LA VEGA",
            "city": "VILLALBA",
            "state": "PR",
            "postal_code": "00766",
            "telephone_number": "787-210-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CARR 14 KM 13.2 URB ORTA LOCAL NUM 5",
            "city": "JUANA DIAZ",
            "state": "PR",
            "postal_code": "00795",
            "telephone_number": "787-210-1400",
            "fax_number": "787-936-7428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDIC LIFE SUPPORT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-09",
        "last_updated": "2023-06-09",
        "certification_date": "2023-06-02",
        "status": "A",
        "authorized_official_last_name": "RESTO COLON",
        "authorized_official_first_name": "WASLEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-210-1400"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Xiomara Martinez, RPH
• Yamila Siyam Martinez, RPH
• Melvin Alvarado Matos Sr.
• Glenda Mayol-Alicea, PSYD
• Med Centro Inc.
• Medicfast Cita Inc
• Olwens Medina Gonzalez
• Norma Ivette Medina, PHARM D.
• Francis Niret Melendez de Jesus, LND
• Joshua Oneil Melendez Sr.

• Land Ambulance in Juana Diaz, PR
• Providers in Juana Diaz, PR by specialty
• Land Ambulance in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.