Provider Demographics
NPI:1922153261
Name:ZALDIVAR BORJAS, JOSE L
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:L
Last Name:ZALDIVAR BORJAS
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:PO BOX 3637
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00958-0637
Mailing Address - Country:US
Mailing Address - Phone:787-642-6100
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL PAVIA
Practice Address - Street 2:CALLE AFIA #1462 LA PARADA #22
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00910
Practice Address - Country:US
Practice Address - Phone:787-642-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6571208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0029659Medicare PIN