Healthcare Provider Details

I. General information

NPI: 1649673559
Provider Name (Legal Business Name): ANA BORBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 W PUTNAM AVE
PORTERVILLE CA
93257-3257
US

IV. Provider business mailing address

19740 AVENUE 152
PORTERVILLE CA
93257-9345
US

V. Phone/Fax

Practice location:
  • Phone: 559-781-3700
  • Fax: 559-781-1230
Mailing address:
  • Phone: 559-782-0433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95001111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: