Provider Demographics
NPI:1912614801
Name:AMADOR BORREGO, NELSON
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:AMADOR BORREGO
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 1:6109 SW 22ND CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-2926
Mailing Address - Country:US
Mailing Address - Phone:786-440-3370
Mailing Address - Fax:
Practice Address - Street 1:6109 SW 22ND CT
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-2926
Practice Address - Country:US
Practice Address - Phone:786-440-3370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician