Provider Demographics
NPI:1306297122
Name:BORGMAN, DOUGLAS (PA-C, CAQ-PSYCH)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:BORGMAN
Suffix:
Gender:M
Credentials:PA-C, CAQ-PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19782 MACARTHUR BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2417
Mailing Address - Country:US
Mailing Address - Phone:714-545-5550
Mailing Address - Fax:949-991-2040
Practice Address - Street 1:999 N TUSTIN AVE STE 216
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6506
Practice Address - Country:US
Practice Address - Phone:714-545-5550
Practice Address - Fax:714-571-0005
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA53467363AM0700X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ000313Medicaid