Healthcare Provider Details

I. General information

NPI: 1528440229
Provider Name (Legal Business Name): ANDRES ELIAS BORRERO MENDOZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 12/19/2020
Certification Date: 12/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PONCE BYP # 2213
PONCE PR
00716-0300
US

IV. Provider business mailing address

901 PORTALES DEL MONTE
COTO LAUREL PR
00780-2009
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-8686
  • Fax:
Mailing address:
  • Phone: 787-235-8977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number140971
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number38253
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number83642
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number320575
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: