Basic Information
| Provider Information | |||||||||
| NPI: | 1093280588 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BORRAJERO | ||||||||
| FirstName: | OBEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 N JACKSON AVE | ||||||||
| Address2: | STE 110 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951161909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197883530 | ||||||||
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| Practice Location | |||||||||
| Address1: | 250 PROSPECT PL | ||||||||
| Address2: | |||||||||
| City: | CORONADO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921181943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195223600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2018 | ||||||||
| LastUpdateDate: | 08/06/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 95010239 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.