Provider Demographics
NPI:1558903161
Name:BORRERO, ISADORA
Entity Type:Individual
Prefix:
First Name:ISADORA
Middle Name:
Last Name:BORRERO
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 1:1850 W HIGHLAND AVE # F101
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5095
Mailing Address - Country:US
Mailing Address - Phone:502-302-0832
Mailing Address - Fax:
Practice Address - Street 1:1850 W HIGHLAND AVE # F101
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5095
Practice Address - Country:US
Practice Address - Phone:502-302-0832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator