Healthcare Provider Details

I. General information

NPI: 1952425001
Provider Name (Legal Business Name): CIRIACO A BORROTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 STATE ROAD 100
MELROSE FL
32666-3146
US

IV. Provider business mailing address

1745 STATE ROAD 100
MELROSE FL
32666-3146
US

V. Phone/Fax

Practice location:
  • Phone: 352-478-2471
  • Fax: 352-478-2496
Mailing address:
  • Phone: 352-478-2471
  • Fax: 352-478-2496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME28392
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME28392
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: