Healthcare Provider Details

I. General information

NPI: 1265751242
Provider Name (Legal Business Name): PAUL CAUTRELL BORGELLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2010
Last Update Date: 05/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2268 NE 174TH ST
NORTH MIAMI BEACH FL
33160-2929
US

IV. Provider business mailing address

2268 NE 174TH ST
NORTH MIAMI BEACH FL
33160-2929
US

V. Phone/Fax

Practice location:
  • Phone: 786-260-9852
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT10482
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: