Provider Demographics
NPI:1528392974
Name:BREAST CARE CENTER BBC PSC
Entity Type:Organization
Organization Name:BREAST CARE CENTER BBC PSC
Other - Org Name:BBC PSC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:ECHENIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-914-3284
Mailing Address - Street 1:735 PONCE DE LEON AVE
Mailing Address - Street 2:SUITE 404 COND TORRE MEDICA AUXILIO MUTUO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-0000
Mailing Address - Country:US
Mailing Address - Phone:787-751-4197
Mailing Address - Fax:787-294-0535
Practice Address - Street 1:735 PONCE DE LEON AVE
Practice Address - Street 2:SUITE 404 COND TORRE MEDICA AUXILIO MUTUO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-0000
Practice Address - Country:US
Practice Address - Phone:787-751-4197
Practice Address - Fax:787-294-0535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR64242086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD34208Medicare UPIN