Basic Information
| Provider Information | |||||||||
| NPI: | 1316951783 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BORRELL | ||||||||
| FirstName: | LEO | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4314 YOAKUM BLVD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770065818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138500049 | ||||||||
| FaxNumber: | 7138500036 | ||||||||
| Practice Location | |||||||||
| Address1: | 4314 YOAKUM BLVD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770065818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138500049 | ||||||||
| FaxNumber: | 7138500036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 09/23/2011 | ||||||||
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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 | 2084P0800X | D8507 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 145262505 | 05 | TX | MEDICAID | 145262504 | 05 | TX | MEDICAID | 260047907 | 01 | TX | RR MCR HOU-H | OTHER | 145262501 | 05 | TX | MEDICAID | 145262503 | 05 | TX | MEDICAID | P00304475 | 01 | TX | RR MCR PSYCHCARE SA | OTHER | 145262506 | 05 | TX | MEDICAID | 145262510 | 05 | TX | MEDICAID | 260047909 | 01 | TX | RR MCR HOU RURAL | OTHER | P00367056 | 01 | TX | RR MCR PSYCHO SA | OTHER | 145262508 | 05 | TX | MEDICAID | 145262511 | 05 | TX | MEDICAID |