Provider Demographics
NPI:1396211827
Name:BORINAGA, RYAN (COTA)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:BORINAGA
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 KERN CANYON LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-2270
Mailing Address - Country:US
Mailing Address - Phone:832-427-7363
Mailing Address - Fax:
Practice Address - Street 1:1402 KERN CANYON LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-2270
Practice Address - Country:US
Practice Address - Phone:832-427-7363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215471224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant