MEDICARE: ED JOSE BORREGO M.D.

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	2084P0800X	Psychiatry Physician	M0670	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00336Z	OTHER	TX	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356342075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ED JOSE BORREGO M.D.

Provider Business Mailing Address
First Line	:	5736 N MESA ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-5427
Country	:	US
Telephone Number	:	915-842-9585
Fax Number	:	915-842-9581

Provider Business Practice Location Address
First Line	:	5750 N MESA ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-5427
Country	:	US
Telephone Number	:	915-842-9585
Fax Number	:	915-842-9581

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	02/16/2010

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Directions to “ ED JOSE BORREGO M.D.” Practice Location

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