Provider Demographics
NPI:1962510578
Name:BORREGO, MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:BORREGO
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 1:3101 FORNEY LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-1607
Mailing Address - Country:US
Mailing Address - Phone:915-317-6033
Mailing Address - Fax:915-595-2231
Practice Address - Street 1:3101 FORNEY LN
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-1607
Practice Address - Country:US
Practice Address - Phone:915-317-6033
Practice Address - Fax:915-595-2231
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN0146239OtherDPS
TXM3476OtherMEDICAL LICENSE
NMMD2005-0204OtherMEDICAL LICENSE
NMMD2005-0204OtherMEDICAL LICENSE