Active NPI
Obel Borrajero
- Nurse Practitioner
- Coronado, CA
National Provider Identifier
1093280588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 95010239
- Practice address
- 250 Prospect PL
Coronado, CA 92118-1943 - Phone
- (619) 522-3600
- NPI assigned
- Oct 10, 2018
- Last updated
- Aug 6, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 95010239 | CA | Primary |
Addresses
Primary practice location
250 Prospect PL
Coronado, CA 92118-1943
Mailing address
175 N Jackson Ave
Ste 110
San Jose, CA 95116-1909
Phone (619) 788-3530
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190109000686 | CA | Practitioner - Nurse Practitioner | 9032455225 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95010239 | CA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1539129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565049600000",
"number": "1093280588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "175 N JACKSON AVE",
"address_2": "STE 110",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951161909",
"telephone_number": "619-788-3530"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "250 PROSPECT PL",
"city": "CORONADO",
"state": "CA",
"postal_code": "921181943",
"telephone_number": "619-522-3600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORRAJERO",
"first_name": "OBEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-10-10",
"last_updated": "2019-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "95010239",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coronado, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.