Provider Demographics
NPI:1013329515
Name:BORROMEO, RALPH JOSEPH REAL (APRN)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:JOSEPH REAL
Last Name:BORROMEO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:4616 W SAHARA AVE
Mailing Address - Street 2:337
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-3654
Mailing Address - Country:US
Mailing Address - Phone:702-227-4040
Mailing Address - Fax:702-227-4727
Practice Address - Street 1:3835 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-7125
Practice Address - Country:US
Practice Address - Phone:702-880-4193
Practice Address - Fax:702-880-4197
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVAPRN001737363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1013329515Medicaid
NV1013329515Medicaid