Healthcare Provider Details

I. General information

NPI: 1255753448
Provider Name (Legal Business Name): ALEJANDRO BORRERO PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2014
Last Update Date: 01/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4404 SANTA INES EXT. STA. TERESITA
PONCE PR
00730-4629
US

IV. Provider business mailing address

4404 SANTA INES EXT. STA. TERESITA
PONCE PR
00730-4629
US

V. Phone/Fax

Practice location:
  • Phone: 787-688-1207
  • Fax:
Mailing address:
  • Phone: 787-688-1207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5396
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number1350
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: