Provider Demographics
NPI:1790737260
Name:BORRERO MC.CORMICK, RAMON ANTONIO (DC, MD)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:ANTONIO
Last Name:BORRERO MC.CORMICK
Suffix:
Gender:M
Credentials:DC, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 CALLE EL VIGIA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-2919
Mailing Address - Country:US
Mailing Address - Phone:787-864-9222
Mailing Address - Fax:
Practice Address - Street 1:8169 CALLE CONCORDIA
Practice Address - Street 2:CONDOMINIO SAN VICENTE SUITE 104
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1554
Practice Address - Country:US
Practice Address - Phone:787-864-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0321111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR35048Medicare UPIN