Healthcare Provider Details

I. General information

NPI: 1114077450
Provider Name (Legal Business Name): MRS. EVELYN BORRERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 ST V1 LAGOS DE PLATA LEVITTOWN
TOA BAJA PR
00949
US

IV. Provider business mailing address

V1 CALLE 19 LEVITTOWN
TOA BAJA PR
00949-3200
US

V. Phone/Fax

Practice location:
  • Phone: 787-784-5475
  • Fax: 787-784-5475
Mailing address:
  • Phone: 787-784-5475
  • Fax: 787-784-5475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1602692
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: