Provider Demographics
NPI:1952425001
Name:BORROTO, CIRIACO A (MD)
Entity Type:Individual
Prefix:DR
First Name:CIRIACO
Middle Name:A
Last Name:BORROTO
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 1:1745 STATE ROAD 100
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:FL
Mailing Address - Zip Code:32666-3146
Mailing Address - Country:US
Mailing Address - Phone:352-478-2471
Mailing Address - Fax:352-478-2496
Practice Address - Street 1:1745 STATE ROAD 100
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:FL
Practice Address - Zip Code:32666-3146
Practice Address - Country:US
Practice Address - Phone:352-478-2471
Practice Address - Fax:352-478-2496
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME28392208600000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056526100Medicaid
FL002209700Medicaid
ME28392OtherME NUMBER
FL056526100Medicaid