Provider Demographics
NPI:1114437407
Name:BORREGO GARCIA, YORDAN (SA-C)
Entity Type:Individual
Prefix:
First Name:YORDAN
Middle Name:
Last Name:BORREGO GARCIA
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:YORDAN
Other - Middle Name:
Other - Last Name:BORREGO GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SA-C
Mailing Address - Street 1:10251SW13ST
Mailing Address - Street 2:
Mailing Address - City:MIANI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2713
Mailing Address - Country:US
Mailing Address - Phone:305-798-6148
Mailing Address - Fax:
Practice Address - Street 1:10251 SW 13TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2713
Practice Address - Country:US
Practice Address - Phone:305-798-6148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
17-535246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB622-960-82-185-0Medicaid