Provider Demographics
NPI:1619081478
Name:BORDEWYK, ROBERTO P
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:P
Last Name:BORDEWYK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SOUTH VIEW ST. BALDWIN PARK
Mailing Address - Street 2:#B-23
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:VA CARIBEAN HEALTH CARE SYSTEM 10 CASIA ST.
Practice Address - Street 2:NUCLEAR MEDICINE (115)
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-641-2906
Practice Address - Fax:787-641-4597
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7691207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine