Provider Demographics
NPI:1437265949
Name:BORREGO, JESUS J (ETC)
Entity type:Individual
Prefix:MR
First Name:JESUS
Middle Name:J
Last Name:BORREGO
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Gender:M
Credentials:ETC
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Other - Credentials:
Mailing Address - Street 1:4765 W 8TH AVE
Mailing Address - Street 2:SUITE 300C
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3554
Mailing Address - Country:US
Mailing Address - Phone:786-426-4611
Mailing Address - Fax:305-825-3834
Practice Address - Street 1:4765 W 8TH AVE
Practice Address - Street 2:SUITE 300C
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3554
Practice Address - Country:US
Practice Address - Phone:786-426-4611
Practice Address - Fax:305-825-3834
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies