MEDICARE: BORREGO COMMUNITY HEALTH FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	080000651	CA

General Provider Information

NPI Number	:	1649330853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BORREGO COMMUNITY HEALTH FOUNDATION

Provider Business Mailing Address
First Line	:	PO BOX 2369
Second Line	:
City	:	BORREGO SPRINGS
State	:	CA
Zip	:	92004-2369
Country	:	US
Telephone Number	:	760-767-4777
Fax Number	:	760-767-4690

Provider Business Practice Location Address
First Line	:	655 PALM CANYON DR.
Second Line	:	STE. C
City	:	BORREGO SPRINGS
State	:	CA
Zip	:	92004-2369
Country	:	US
Telephone Number	:	760-767-4777
Fax Number	:	760-767-4690

Authorized Official
Title or Position	:	CEO
Name	:	MR. BRUCE HEBETS
Credential	:
Telephone Number	:	760-767-5051

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	02/19/2013

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