Provider Demographics
NPI:1548439045
Name:AZAEL P BORROMEO MD PA
Entity type:Organization
Organization Name:AZAEL P BORROMEO MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MERRY
Authorized Official - Middle Name:DOLL
Authorized Official - Last Name:BORROMEO
Authorized Official - Suffix:
Authorized Official - Credentials:
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0035326261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108911Medicare Oscar/Certification