Provider Demographics
NPI:1811750722
Name:BORGQUIST, GREG GUY
Entity type:Individual
Prefix:MR
First Name:GREG
Middle Name:GUY
Last Name:BORGQUIST
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 1:3107 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERBANK
Mailing Address - State:CA
Mailing Address - Zip Code:95367-2038
Mailing Address - Country:US
Mailing Address - Phone:209-402-6988
Mailing Address - Fax:
Practice Address - Street 1:3107 RIVERSIDE DR
Practice Address - Street 2:RIVERBANK, CA. 95367
Practice Address - City:RIVERBANK
Practice Address - State:CA
Practice Address - Zip Code:95367
Practice Address - Country:US
Practice Address - Phone:209-402-6988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst