1295089084 NPI number — D&D BREAST SURGEONS, PSC

Table of content: (NPI 1295089084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295089084 NPI number — D&D BREAST SURGEONS, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
D&D BREAST SURGEONS, PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295089084
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
909 TITO CASTRO AVE
Provider Second Line Business Mailing Address:
TORRE MEDICA SAN LUCAS SUITE 502
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00716-4728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-651-3888
Provider Business Mailing Address Fax Number:
787-651-7325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
909 TITO CASTRO AVE.
Provider Second Line Business Practice Location Address:
TORRE MEDICA SAN LUCAS SUITE 502
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00716-4728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-651-3888
Provider Business Practice Location Address Fax Number:
787-651-7325
Provider Enumeration Date:
11/01/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DIAZ NEGRON
Authorized Official First Name:
ZULEIKA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-651-3888

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  15945 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 15945 . This is a "LIC MD" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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