Provider Demographics
NPI:1215232475
Name:BORRERO, MARIA ELISA (MA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELISA
Last Name:BORRERO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5844 MOHR LOOP
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3108
Mailing Address - Country:US
Mailing Address - Phone:813-299-2390
Mailing Address - Fax:
Practice Address - Street 1:5844 MOHR LOOP
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3108
Practice Address - Country:US
Practice Address - Phone:813-299-2390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 60060225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA60060OtherMASSAGE THERAPY