Provider Demographics
NPI:1144823014
Name:ALVARADO BORGES, BRAULYS (SA-C)
Entity type:Individual
Prefix:
First Name:BRAULYS
Middle Name:
Last Name:ALVARADO BORGES
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 CONWAY RD APT 601
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-8337
Mailing Address - Country:US
Mailing Address - Phone:786-319-7446
Mailing Address - Fax:
Practice Address - Street 1:2311 CONWAY RD APT 601
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-8337
Practice Address - Country:US
Practice Address - Phone:786-319-7446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-450246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant