Provider Demographics
NPI:1578502654
Name:BREAST CANCER INSTITUTE C S P
Entity Type:Organization
Organization Name:BREAST CANCER INSTITUTE C S P
Other - Org Name:ADVANCED BREAST CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:VIDAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-735-0444
Mailing Address - Street 1:PO BOX 1390
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-1390
Mailing Address - Country:US
Mailing Address - Phone:787-738-8077
Mailing Address - Fax:787-738-8095
Practice Address - Street 1:CARRETERA 14 KM 72.2
Practice Address - Street 2:PLAZA MILIANGIE LOCAL #6
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-738-8077
Practice Address - Fax:787-738-8095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84894BROtherTRIPLE S
PR7360000OtherHUMANA