Healthcare Provider Details

I. General information

NPI: 1700413531
Provider Name (Legal Business Name): MARIELLE BOROM DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. MARIELLE O'HARA-HULETT

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

856 HEALTH SCIENCES RD
IRVINE CA
92617-3058
US

IV. Provider business mailing address

856 HEALTH SCIENCES RD
IRVINE CA
92617-3058
US

V. Phone/Fax

Practice location:
  • Phone: 949-824-8685
  • Fax:
Mailing address:
  • Phone: 949-824-8685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A23114
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: