Provider Demographics
NPI:1073571063
Name:BORNIA, MANUEL RAFAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:RAFAEL
Last Name:BORNIA
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 1:180 JFK DR STE 260
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6642
Mailing Address - Country:US
Mailing Address - Phone:561-439-4480
Mailing Address - Fax:561-641-6626
Practice Address - Street 1:180 JFK DR STE 260
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6642
Practice Address - Country:US
Practice Address - Phone:561-439-4480
Practice Address - Fax:561-641-6626
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47911174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024429200Medicaid