1518254051 NPI number — DR. MIGUEL FERNANDO BORDA D.M.D

Table of content: DR. MIGUEL FERNANDO BORDA D.M.D (NPI 1518254051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518254051 NPI number — DR. MIGUEL FERNANDO BORDA D.M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORDA
Provider First Name:
MIGUEL
Provider Middle Name:
FERNANDO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518254051
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12033 ACME ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELLINGTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-596-2227
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1825 FOREST HILL BLVD
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-733-9099
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DN19392 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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