=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013097237
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPREHENSIVE BREAST CENTER LIMITED PARTNERSHIP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2006
-----------------------------------------------------
Last Update Date | 09/25/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9090 SW 87TH CT SUITE 102
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176-2315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-271-8394
-----------------------------------------------------
Fax | 305-675-3627
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 160608
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33116-0608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-279-7275
-----------------------------------------------------
Fax | 786-219-2908
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ALVARO GARCIA VILLEGAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-279-7275
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0206X
-----------------------------------------------------
Taxonomy Name | Mammography Clinic/Center
-----------------------------------------------------
License Number | HCC10405
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------