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General NPI Number Information
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NPI Number | 1669415709
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Entity Type | Individual
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Provider Name | JOSE R TAVAREZ BORRELL MD
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Gender | Male
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 02/21/2011
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Provider Practice Location Address
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Address Line | 124 AVE WINSTON CHURCHILL EDIF EL SENORIAL, OFICINA 310
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City | RIO PIEDRAS
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State | PR
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Zip | 00926-6064
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Country | US
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Telephone | 787-274-2862
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Fax | 787-274-2862
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Provider Business Mailing Address
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Address Line | 355 CALLE CITADEL REPARTO UNIVERSITARIO
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City | SAN JUAN
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State | PR
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Zip | 00926-1824
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Country | US
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Telephone | 787-767-1593
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 14299
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License Number State | PR
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