Provider Demographics
NPI:1679707806
Name:ADVANCED BREAST CLINICS
Entity Type:Organization
Organization Name:ADVANCED BREAST CLINICS
Other - Org Name:ADVANCED BREAST CLINICS, IMAGING AND DIAGNOSTIC CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:787-318-8930
Mailing Address - Street 1:PO BOX 633
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-0633
Mailing Address - Country:US
Mailing Address - Phone:787-784-5706
Mailing Address - Fax:
Practice Address - Street 1:1000 AVE DOS PALMAS
Practice Address - Street 2:LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4101
Practice Address - Country:US
Practice Address - Phone:787-784-5706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13446261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRNPIOther1205814761