Provider Demographics
NPI:1295089084
Name:D&D BREAST SURGEONS, PSC
Entity type:Organization
Organization Name:D&D BREAST SURGEONS, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZULEIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ NEGRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-651-3888
Mailing Address - Street 1:909 TITO CASTRO AVE
Mailing Address - Street 2:TORRE MEDICA SAN LUCAS SUITE 502
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-4728
Mailing Address - Country:US
Mailing Address - Phone:787-651-3888
Mailing Address - Fax:787-651-7325
Practice Address - Street 1:909 TITO CASTRO AVE.
Practice Address - Street 2:TORRE MEDICA SAN LUCAS SUITE 502
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4728
Practice Address - Country:US
Practice Address - Phone:787-651-3888
Practice Address - Fax:787-651-7325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-01
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15945208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR15945OtherLIC MD