Provider Demographics
NPI:1841269206
Name:BORLONGAN, MARIO S JR (MD)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:S
Last Name:BORLONGAN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:9524 W CAMELBACK RD
Mailing Address - Street 2:STE. 130-381
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-3104
Mailing Address - Country:US
Mailing Address - Phone:623-584-5250
Mailing Address - Fax:623-584-4587
Practice Address - Street 1:14780 W MOUNTAIN VIEW BLVD
Practice Address - Street 2:STE 201
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-7281
Practice Address - Country:US
Practice Address - Phone:623-584-5250
Practice Address - Fax:623-584-4587
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
AZ31440208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ774291-01Medicaid
AZ774291-01Medicaid
AZZ74544Medicare PIN
AZG51826Medicare UPIN