Provider Demographics
NPI:1265490676
Name:BORSA, VALERIE JEAN (MD)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:JEAN
Last Name:BORSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 BENEDICTA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-2004
Mailing Address - Country:US
Mailing Address - Phone:719-846-8478
Mailing Address - Fax:719-846-2941
Practice Address - Street 1:409 BENEDICTA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2004
Practice Address - Country:US
Practice Address - Phone:719-846-8478
Practice Address - Fax:719-846-2941
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38779207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO97823741Medicaid
CO012426OtherKAISER COMMERCIAL NUMBER
COCOAAA3211Medicare PIN
CO811686Medicare PIN
COH29168Medicare UPIN
CO97823741Medicaid