Provider Demographics
NPI:1184628836
Name:BORRERO, LYSANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:LYSANDER
Middle Name:
Last Name:BORRERO
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:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785
Mailing Address - Country:US
Mailing Address - Phone:787-929-1833
Mailing Address - Fax:
Practice Address - Street 1:AVE. ASHFORT-URB. GIBRALTAR #1 OFICINA-3(BAJOS)
Practice Address - Street 2:AVE. ASHFORT-URB. GIBRALTAR #1 OFICINA-3(BAJOS)
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-864-6898
Practice Address - Fax:787-864-6895
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-10
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9397208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82631Medicare ID - Type Unspecified