Provider Demographics
NPI:1922085364
Name:WOMEN'S BREAST CARE CENTER, INC
Entity Type:Organization
Organization Name:WOMEN'S BREAST CARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LACLAUSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-965-1100
Mailing Address - Street 1:3319 STATE ROAD 7
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8094
Mailing Address - Country:US
Mailing Address - Phone:561-965-1100
Mailing Address - Fax:561-965-4143
Practice Address - Street 1:3319 STATE ROAD 7
Practice Address - Street 2:SUITE 105
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8094
Practice Address - Country:US
Practice Address - Phone:561-965-1100
Practice Address - Fax:561-965-4143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME52092174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD21058Medicare UPIN