Healthcare Provider Details

I. General information

NPI: 1619081478
Provider Name (Legal Business Name): DR. ROBERTO P. BORDEWYK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA CARIBEAN HEALTH CARE SYSTEM 10 CASIA ST. NUCLEAR MEDICINE (115)
SAN JUAN PR
00921
US

IV. Provider business mailing address

SOUTH VIEW ST. BALDWIN PARK #B-23
GUAYNABO PR
00969
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-2906
  • Fax: 787-641-4597
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number7691
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: