Provider Demographics
NPI:1114077450
Name:BORRERO, EVELYN
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:
Last Name:BORRERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:V1 CALLE 19
Mailing Address - Street 2:LEVITTOWN
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-3200
Mailing Address - Country:US
Mailing Address - Phone:787-784-5475
Mailing Address - Fax:787-784-5475
Practice Address - Street 1:19 ST V1 LAGOS DE PLATA
Practice Address - Street 2:LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-784-5475
Practice Address - Fax:787-784-5475
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16026923416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport