Healthcare Provider Details

I. General information

NPI: 1528392974
Provider Name (Legal Business Name): BREAST CARE CENTER BBC PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 PONCE DE LEON AVE SUITE 404 COND TORRE MEDICA AUXILIO MUTUO
SAN JUAN PR
00917-0000
US

IV. Provider business mailing address

735 PONCE DE LEON AVE SUITE 404 COND TORRE MEDICA AUXILIO MUTUO
SAN JUAN PR
00917-0000
US

V. Phone/Fax

Practice location:
  • Phone: 787-751-4197
  • Fax: 787-294-0535
Mailing address:
  • Phone: 787-751-4197
  • Fax: 787-294-0535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number6424
License Number StatePR

VIII. Authorized Official

Name: DR. MIGUEL M ECHENIQUE
Title or Position: PRESIDENT
Credential: MD
Phone: 787-914-3284