Individual
MIMI ROSEALIE BORRELLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(650) 283-8746
Mailing address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(650) 283-8746
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
LP05003
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
219-177-128
GREEN CARD
—
01
—
LP05003
LICENSE NUMBER
—
Enumeration date
06/03/2020
Last updated
06/03/2020
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