MEDICARE: ADVANCED BREAST CLINICS

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	261QR0206X	Mammography Clinic/Center	13446	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NPI	OTHER	PR	1205814761

General Provider Information

NPI Number	:	1679707806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED BREAST CLINICS

Provider Business Mailing Address
First Line	:	PO BOX 633
Second Line	:
City	:	DORADO
State	:	PR
Zip	:	00646-0633
Country	:	US
Telephone Number	:	787-784-5706
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 AVE DOS PALMAS
Second Line	:	LEVITTOWN
City	:	TOA BAJA
State	:	PR
Zip	:	00949-4101
Country	:	US
Telephone Number	:	787-784-5706
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CARLOS A SANTIAGO
Credential	:	MD, FACS
Telephone Number	:	787-318-8930

Provider Enumeration Date	:	05/01/2009
Last Update Date	:	05/01/2009

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