Provider Demographics
NPI:1710695309
Name:MADELIN MOYA BORROTO MD PA
Entity Type:Organization
Organization Name:MADELIN MOYA BORROTO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MADELIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYA BORROTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-309-0160
Mailing Address - Street 1:15418 SW 31ST LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5900
Mailing Address - Country:US
Mailing Address - Phone:786-309-0160
Mailing Address - Fax:786-329-7430
Practice Address - Street 1:3850 SW 87TH AVE STE 306
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-5474
Practice Address - Country:US
Practice Address - Phone:305-608-0656
Practice Address - Fax:786-329-7430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization