Healthcare Provider Details

I. General information

NPI: 1366741241
Provider Name (Legal Business Name): BREAST CARE AND SURGERY CENTER PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 PORTALES DEL MONTE
COTO LAUREL PR
00780-2005
US

IV. Provider business mailing address

601 PORTALES DEL MONTE
COTO LAUREL PR
00780-2005
US

V. Phone/Fax

Practice location:
  • Phone: 787-340-9888
  • Fax: 787-813-2154
Mailing address:
  • Phone: 787-340-9888
  • Fax: 787-813-2154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number13623
License Number StatePR

VIII. Authorized Official

Name: DR. JORGE A TORO-BURGUETE
Title or Position: PRESIDENT
Credential: MD
Phone: 787-340-9888