Provider Demographics
NPI:1235300302
Name:BORELLO, RICHARD NIEL (HIS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:NIEL
Last Name:BORELLO
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 N MOUNTAIN AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5714
Mailing Address - Country:US
Mailing Address - Phone:909-931-3166
Mailing Address - Fax:909-941-4186
Practice Address - Street 1:222 N MOUNTAIN AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5714
Practice Address - Country:US
Practice Address - Phone:909-931-3166
Practice Address - Fax:909-941-4186
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA7295237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist