Provider Demographics
NPI:1467469114
Name:BORGQUIST, JAMES BLEAK (CP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BLEAK
Last Name:BORGQUIST
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7921 PROFESSIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1901
Mailing Address - Country:US
Mailing Address - Phone:714-847-8751
Mailing Address - Fax:714-847-8913
Practice Address - Street 1:7921 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1901
Practice Address - Country:US
Practice Address - Phone:714-847-8751
Practice Address - Fax:714-847-8913
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACP2925224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5441790001OtherPTAN
CAXB0029250OtherMEDI-CAL
CAZZZ64903ZOtherBLUE SHIELD