Provider Demographics
NPI:1568546505
Name:BORLONGAN, OFELIA K (MD)
Entity Type:Individual
Prefix:DR
First Name:OFELIA
Middle Name:K
Last Name:BORLONGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 ELDREDGE RD
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1346
Mailing Address - Country:US
Mailing Address - Phone:850-864-1598
Mailing Address - Fax:
Practice Address - Street 1:153 ELDREDGE RD
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1346
Practice Address - Country:US
Practice Address - Phone:850-864-1598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME029742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A81659Medicare UPIN