Provider Demographics
NPI:1659410652
Name:PALM BEACH TRAUMA ASSOCIATES
Entity Type:Organization
Organization Name:PALM BEACH TRAUMA ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CORI
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BORREGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-799-9559
Mailing Address - Street 1:2560 RCA BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3336
Mailing Address - Country:US
Mailing Address - Phone:561-799-9559
Mailing Address - Fax:561-799-9577
Practice Address - Street 1:2560 RCA BLVD STE 106
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3336
Practice Address - Country:US
Practice Address - Phone:561-799-9559
Practice Address - Fax:561-799-9577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250031100Medicaid