Provider Demographics
NPI:1750046546
Name:BORBOA, ADAM
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:BORBOA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4762 E ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4002
Mailing Address - Country:US
Mailing Address - Phone:520-409-3545
Mailing Address - Fax:
Practice Address - Street 1:4762 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4002
Practice Address - Country:US
Practice Address - Phone:520-409-3545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL11970H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility