MEDICARE: STEREOTACTIC BREAST CENTER PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1407850738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEREOTACTIC BREAST CENTER PSC

Provider Business Mailing Address
First Line	:	P. O. BOX 9003
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00960-8038
Country	:	US
Telephone Number	:	787-740-3500
Fax Number	:	787-995-6887

Provider Business Practice Location Address
First Line	:	BAYAMON MEDICAL PLZ
Second Line	:	STE 201
City	:	BAYAMON
State	:	PR
Zip	:	00959-7200
Country	:	US
Telephone Number	:	787-740-3500
Fax Number	:	787-995-6887

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. ZENAIDA MENDEZ RIVERA
Credential	:	M.D.
Telephone Number	:	787-740-2120

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	03/17/2011

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