Provider Demographics
NPI:1093093767
Name:BORREGO INDEPENDENT PHYSICIANS ASSOCIATION
Entity Type:Organization
Organization Name:BORREGO INDEPENDENT PHYSICIANS ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEBETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-704-3770
Mailing Address - Street 1:955 HARBOR ISLAND DR STE 162
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-1082
Mailing Address - Country:US
Mailing Address - Phone:619-704-3770
Mailing Address - Fax:619-704-3775
Practice Address - Street 1:955 HARBOR ISLAND DR STE 162
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-1082
Practice Address - Country:US
Practice Address - Phone:619-704-3770
Practice Address - Fax:619-704-3775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty