Provider Demographics
NPI:1952312621
Name:BORRERO, MARCOS (MD)
Entity Type:Individual
Prefix:
First Name:MARCOS
Middle Name:
Last Name:BORRERO
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 1:3490 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-1664
Mailing Address - Country:US
Mailing Address - Phone:619-421-5279
Mailing Address - Fax:
Practice Address - Street 1:3490 PALM AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-1664
Practice Address - Country:US
Practice Address - Phone:619-423-5616
Practice Address - Fax:619-423-5684
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA389071208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A389071Medicaid
CA00A389071Medicaid