Provider Demographics
NPI:1528440229
Name:BORRERO MENDOZA, ANDRES ELIAS (MD)
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:ELIAS
Last Name:BORRERO MENDOZA
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 1:901 PORTALES DEL MONTE
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2009
Mailing Address - Country:US
Mailing Address - Phone:787-235-8977
Mailing Address - Fax:
Practice Address - Street 1:PONCE BYP # 2213
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-0300
Practice Address - Country:US
Practice Address - Phone:787-840-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL140971207P00000X
AL38253207P00000X
GA83642207P00000X
LA320575207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty