Provider Demographics
NPI:1932281235
Name:BORROMEO, AZAEL P (MD)
Entity Type:Individual
Prefix:DR
First Name:AZAEL
Middle Name:P
Last Name:BORROMEO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WILLIAM TELL LN
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34465-3785
Mailing Address - Country:US
Mailing Address - Phone:352-527-9555
Mailing Address - Fax:352-527-2609
Practice Address - Street 1:2 WILLIAM TELL LN
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-3785
Practice Address - Country:US
Practice Address - Phone:352-527-9555
Practice Address - Fax:352-527-2609
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0035326207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC34944Medicare UPIN
108911Medicare Oscar/Certification