Provider Demographics
NPI:1225013402
Name:INSTITUTO DE CUIDADO DEL SENO
Entity type:Organization
Organization Name:INSTITUTO DE CUIDADO DEL SENO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-641-0209
Mailing Address - Street 1:BAYAMON MEDICAL PLZ
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-7200
Mailing Address - Country:US
Mailing Address - Phone:787-641-0209
Mailing Address - Fax:787-779-8178
Practice Address - Street 1:BAYAMON MEDICAL PLZ
Practice Address - Street 2:SUITE 209
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7200
Practice Address - Country:US
Practice Address - Phone:787-641-0209
Practice Address - Fax:787-779-8178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2013INOtherTRIPLE S
RX76715OtherUIA
061658OtherCAZ
7605OtherIMC
9590095OtherHUMANA
PE4737OtherPALIC
2013INOtherTRIPLE S
=========OtherCOSVIMED
9590095OtherHUMANA