Provider Demographics
NPI:1649330853
Name:BORREGO COMMUNITY HEALTH FOUNDATION
Entity type:Organization
Organization Name:BORREGO COMMUNITY HEALTH FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEBETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-767-5051
Mailing Address - Street 1:PO BOX 2369
Mailing Address - Street 2:
Mailing Address - City:BORREGO SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92004-2369
Mailing Address - Country:US
Mailing Address - Phone:760-767-4777
Mailing Address - Fax:760-767-4690
Practice Address - Street 1:655 PALM CANYON DR.
Practice Address - Street 2:STE. C
Practice Address - City:BORREGO SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92004-2369
Practice Address - Country:US
Practice Address - Phone:760-767-4777
Practice Address - Fax:760-767-4690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000651207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551928Medicare Oscar/Certification