MEDICARE: KIM BORBA

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	174400000X	Specialist

General Provider Information

NPI Number	:	1942890256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM BORBA

Provider Business Mailing Address
First Line	:	2777 YULUPA AVE STE 611
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-8584
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3843 SACRAMENTO AVE
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-8009
Country	:	US
Telephone Number	:	707-292-2394
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2021
Last Update Date	:	01/27/2021

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Directions to “ KIM BORBA ” Practice Location

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