Provider Demographics
NPI:1073812822
Name:BORGES, THEODORE PATRICK (CNAHHA)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:PATRICK
Last Name:BORGES
Suffix:
Gender:M
Credentials:CNAHHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-0378
Mailing Address - Country:US
Mailing Address - Phone:760-464-4987
Mailing Address - Fax:
Practice Address - Street 1:73455 SHADOW MOUNTAIN DR
Practice Address - Street 2:APT. 2
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4700
Practice Address - Country:US
Practice Address - Phone:760-464-4987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00211233172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker