Provider Demographics
NPI:1578027090
Name:ZBOROWSKI, ELIZABETH (OT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ZBOROWSKI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:JORGENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1015 MOANA DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-4106
Mailing Address - Country:US
Mailing Address - Phone:858-205-9194
Mailing Address - Fax:
Practice Address - Street 1:1015 MOANA DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-4106
Practice Address - Country:US
Practice Address - Phone:858-205-9194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5815225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5815OtherCALIFORNIA BOARD OF OCCUPATIONAL THERAPY