Healthcare Provider Details

I. General information

NPI: 1306297122
Provider Name (Legal Business Name): DOUGLAS BORGMAN PA-C, CAQ-PSYCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 N TUSTIN AVE STE 216
SANTA ANA CA
92705-6506
US

IV. Provider business mailing address

19782 MACARTHUR BLVD STE 300
IRVINE CA
92612-2417
US

V. Phone/Fax

Practice location:
  • Phone: 714-545-5550
  • Fax: 714-571-0005
Mailing address:
  • Phone: 714-545-5550
  • Fax: 949-991-2040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA53467
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberPA53467
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: