Healthcare Provider Details

I. General information

NPI: 1184534653
Provider Name (Legal Business Name): BRENDA BORGOSANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1928 ROCK SPRINGS DR
LAS VEGAS NV
89128-8313
US

IV. Provider business mailing address

449 CROCUS HILL ST
LAS VEGAS NV
89138-1552
US

V. Phone/Fax

Practice location:
  • Phone: 781-786-1247
  • Fax:
Mailing address:
  • Phone: 781-786-1247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberNVMT.12159
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: