Provider Demographics
NPI:1194429258
Name:BORRELLO, OLIVIA DUGAS
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:DUGAS
Last Name:BORRELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 LEMON ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2629
Mailing Address - Country:US
Mailing Address - Phone:504-722-8697
Mailing Address - Fax:
Practice Address - Street 1:3434 PRYTANIA ST STE 410
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3574
Practice Address - Country:US
Practice Address - Phone:504-325-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program