Provider Demographics
NPI:1871741579
Name:AZAEL P. BORROMEO, M.D., P..
Entity type:Organization
Organization Name:AZAEL P. BORROMEO, M.D., P..
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AZAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:BORROMEO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-527-9555
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME35326261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC34944Medicare UPIN