Healthcare Provider Details

I. General information

NPI: 1982240966
Provider Name (Legal Business Name): REBECCA BORUSKO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 09/05/2022
Certification Date: 09/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 OYSTER POINT BLVD STE 512
SOUTH SAN FRANCISCO CA
94080-1973
US

IV. Provider business mailing address

601 WALNUT AVE APT A
SOUTH SAN FRANCISCO CA
94080-2721
US

V. Phone/Fax

Practice location:
  • Phone: 650-826-2945
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95016998
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95185871
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: