Healthcare Provider Details

I. General information

NPI: 1588970313
Provider Name (Legal Business Name): BORREGO INDEPENDENT PHYSICIANS ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 HARBOR ISLAND DR SUITE 162
SAN DIEGO CA
92101-1035
US

IV. Provider business mailing address

955 HARBOR ISLAND DR SUITE 162
SAN DIEGO CA
92101-1035
US

V. Phone/Fax

Practice location:
  • Phone: 858-344-5545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA77736
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE1514
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number58252
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC42220
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20A8287
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA34382
License Number StateCA

VIII. Authorized Official

Name: ALFREDO RATNIEWSKI
Title or Position: CHAIRMAN OF THE BOARD
Credential: M.D.
Phone: 760-871-0606