Healthcare Provider Details

I. General information

NPI: 1407850738
Provider Name (Legal Business Name): STEREOTACTIC BREAST CENTER PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BAYAMON MEDICAL PLZ STE 201
BAYAMON PR
00959-7200
US

IV. Provider business mailing address

P. O. BOX 9003
BAYAMON PR
00960-8038
US

V. Phone/Fax

Practice location:
  • Phone: 787-740-3500
  • Fax: 787-995-6887
Mailing address:
  • Phone: 787-740-3500
  • Fax: 787-995-6887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ZENAIDA MENDEZ RIVERA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-740-2120