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NPI Code Detail

MEDICARE: DR. LYDIA BORJAS ESTANISLAO M.D.

MEDICARE:  DR. LYDIA BORJAS ESTANISLAO  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084N0400XNeurology Physician11106NV

General Provider Information

NPI Number : 1154375798
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LYDIA BORJAS ESTANISLAO M.D.
Provider Business Mailing Address
First Line : 4206 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1625
Country : US
Telephone Number : 702-331-6709
Fax Number : 888-624-0181
Provider Business Practice Location Address
First Line : 4206 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1625
Country : US
Telephone Number : 702-331-6709
Fax Number : 888-624-0181
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2006
Last Update Date : 05/17/2016

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