Provider Demographics
NPI:1124361829
Name:BORGES, JESUS E (CRT)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:E
Last Name:BORGES
Suffix:
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 LUDLAM DR APT 9
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-4971
Mailing Address - Country:US
Mailing Address - Phone:305-884-2986
Mailing Address - Fax:786-462-4330
Practice Address - Street 1:601 LUDLAM DR APT 9
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-4971
Practice Address - Country:US
Practice Address - Phone:305-884-2986
Practice Address - Fax:786-462-4330
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRT69731247100000X
FLCNA138224374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No374U00000XNursing Service Related ProvidersHome Health Aide