Healthcare Provider Details

I. General information

NPI: 1528265402
Provider Name (Legal Business Name): CARMELA BORROMEO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 11/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N TUSTIN AVE SUITE 360
SANTA ANA CA
92705-8644
US

IV. Provider business mailing address

2415 CAMPUS DR SUITE 110
IRVINE CA
92612-1527
US

V. Phone/Fax

Practice location:
  • Phone: 949-999-3631
  • Fax: 949-999-8371
Mailing address:
  • Phone: 949-999-3600
  • Fax: 949-769-8996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT26366
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: