Provider Demographics
NPI:1548377146
Name:MMD BREAST IMAGING
Entity type:Organization
Organization Name:MMD BREAST IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-785-8110
Mailing Address - Street 1:EDIFICIO MEDICO STA. CRUZ
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-785-8110
Mailing Address - Fax:787-798-4630
Practice Address - Street 1:EDIFICIO MEDICO SANTA CRUZ #73
Practice Address - Street 2:CALLE SANTA CRUZ OFICINA 108-109
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-785-8110
Practice Address - Fax:787-798-4630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0082009Medicare PIN