Provider Demographics
NPI:1518467505
Name:BORGES, VIVIAN G
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:G
Last Name:BORGES
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 1:7032 AVE AGUSTIN RAMOS CALERO
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-3432
Mailing Address - Country:US
Mailing Address - Phone:787-872-2860
Mailing Address - Fax:787-872-0838
Practice Address - Street 1:7032 AVE AGUSTIN RAMOS CALERO
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-3432
Practice Address - Country:US
Practice Address - Phone:787-872-2860
Practice Address - Fax:787-872-0838
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1631183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1631OtherTECNICO DE FARMACIA
PR1981400OtherLIC. DE CONDUCIR