MEDICARE: DR. CARLOS JAVIER BORRERO SR.

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
1	367500000X	Certified Registered Nurse Anesthetist	1153	PR

General Provider Information

NPI Number	:	1861356966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS JAVIER BORRERO SR.

Provider Business Mailing Address
First Line	:	845 N STATE ST UNIT 1110
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60610-3324
Country	:	US
Telephone Number	:	787-356-7043
Fax Number	:

Provider Business Practice Location Address
First Line	:	541 N FAIRBANKS CT
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-3319
Country	:	US
Telephone Number	:	787-356-7043
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	12/12/2025

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