Provider Demographics
NPI:1013365121
Name:BORRERO CUELLO, JOSE CARLOS (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:CARLOS
Last Name:BORRERO CUELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB LOS MAESTROS
Mailing Address - Street 2:132 HIJA DEL CARIBE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:616-570-9897
Mailing Address - Fax:616-570-9897
Practice Address - Street 1:URB LOS MAESTROS
Practice Address - Street 2:132 HIJA DEL CARIBE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:616-570-9897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21129261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care