Provider Demographics
NPI:1225890346
Name:BORREGO STAT CARE
Entity Type:Organization
Organization Name:BORREGO STAT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-837-0321
Mailing Address - Street 1:73211 FRED WARING DR STE 101
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-2888
Mailing Address - Country:US
Mailing Address - Phone:760-837-0321
Mailing Address - Fax:760-837-9114
Practice Address - Street 1:587 PALM CANYON DR # 215
Practice Address - Street 2:
Practice Address - City:BORREGO SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92004-4000
Practice Address - Country:US
Practice Address - Phone:760-837-0321
Practice Address - Fax:760-837-9114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty