Healthcare Provider Details

I. General information

NPI: 1750576450
Provider Name (Legal Business Name): BREAST SPECIALTY CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 12/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 LAS LOMAS RD NE SUITE 1
ALBUQUERQUE NM
87102-2634
US

IV. Provider business mailing address

1010 LAS LOMAS RD NE SUITE 1
ALBUQUERQUE NM
87102-2634
US

V. Phone/Fax

Practice location:
  • Phone: 505-248-1518
  • Fax: 505-248-1610
Mailing address:
  • Phone: 505-248-1518
  • Fax: 505-248-1610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number83-108
License Number StateNM

VIII. Authorized Official

Name: DR. SUSAN A. SEEDMAN
Title or Position: PRESIDENT/OWNER
Credential: MD, FACS
Phone: 505-248-1518