Provider Demographics
NPI:1649458449
Name:BORGES, KRYSTAL LYNN
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:LYNN
Last Name:BORGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19029 PIRES AVE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-7350
Mailing Address - Country:US
Mailing Address - Phone:562-882-4522
Mailing Address - Fax:
Practice Address - Street 1:19029 PIRES AVE
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-7350
Practice Address - Country:US
Practice Address - Phone:562-882-4522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services