Provider Demographics
NPI:1225266620
Name:BORGHANS, MAARTEN W
Entity Type:Individual
Prefix:
First Name:MAARTEN
Middle Name:W
Last Name:BORGHANS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 3RD ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-4136
Mailing Address - Country:US
Mailing Address - Phone:310-403-9508
Mailing Address - Fax:
Practice Address - Street 1:2807 3RD ST APT 4
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-4136
Practice Address - Country:US
Practice Address - Phone:310-403-9508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0G20789171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor