1528776408 NPI number — MMD BREAST IMAGING PSC

Table of content: (NPI 1528776408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528776408 NPI number — MMD BREAST IMAGING PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MMD BREAST IMAGING 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:
6
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:
1528776408
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PASEO SAN JUAN G23
Provider Second Line Business Mailing Address:
CALLE ADOQUINES
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926-6520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-630-3116
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SANTA CRUZ MEDICAL BUILDING, SUITE 108
Provider Second Line Business Practice Location Address:
#73 SANTA CRUZ STREET
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-785-8110
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/09/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MALDONADO
Authorized Official First Name:
MAYRA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-630-3116

Provider Taxonomy Codes

  • Taxonomy code: 2085B0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085D0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085U0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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