Provider Demographics
NPI:1861487100
Name:BORRILLO, JESUS LUIGI (MD)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:LUIGI
Last Name:BORRILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2485 HOSPITAL DR
Mailing Address - Street 2:STE 200, ORCHARD PAVILION
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4101
Mailing Address - Country:US
Mailing Address - Phone:650-988-7480
Mailing Address - Fax:650-988-7482
Practice Address - Street 1:2485 HOSPITAL DR
Practice Address - Street 2:STE 200, ORCHARD PAVILION
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4101
Practice Address - Country:US
Practice Address - Phone:650-988-7480
Practice Address - Fax:650-988-7482
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A78255207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A78255Medicaid
CA00A78255Medicaid
CABY001YMedicare PIN
CABY001XMedicare PIN
H24264Medicare UPIN