Healthcare Provider Details

I. General information

NPI: 1053010710
Provider Name (Legal Business Name): RYAN BORLAND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32301 TANNAT DR
TEMECULA CA
92591-0385
US

IV. Provider business mailing address

32301 TANNAT DR
TEMECULA CA
92591-0385
US

V. Phone/Fax

Practice location:
  • Phone: 949-441-2290
  • Fax:
Mailing address:
  • Phone: 949-307-4550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT134984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: