Provider Demographics
NPI:1326634148
Name:BORINAGA, MARY JANE (PT)
Entity Type:Individual
Prefix:
First Name:MARY JANE
Middle Name:
Last Name:BORINAGA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 FAIRVIEW AVE APT 5B
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-6651
Mailing Address - Country:US
Mailing Address - Phone:626-203-6361
Mailing Address - Fax:
Practice Address - Street 1:1899 N RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-1733
Practice Address - Country:US
Practice Address - Phone:626-797-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36225225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist