Healthcare Provider Details

I. General information

NPI: 1497282123
Provider Name (Legal Business Name): BRENDA BORGES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 05/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2067 MASSACHUSETTS AVE
CAMBRIDGE MA
02140-1340
US

IV. Provider business mailing address

625 THOMAS BURGIN PKWY APT 239
QUINCY MA
02169-7650
US

V. Phone/Fax

Practice location:
  • Phone: 617-575-5570
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number164X00000X
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: