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General NPI Number Information
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NPI Number | 1194389452
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Entity Type | Individual
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Provider Name | ADAM D. BORECKY MD
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Gender | Male
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Dates
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Enumeration Date | 04/23/2019
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 333 CORPORATE DR STE 260
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City | LADERA RANCH
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State | CA
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Zip | 92694-2180
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Country | US
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Telephone | 949-768-2988
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Fax | 949-768-2980
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Provider Business Mailing Address
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Address Line | 2807 LAKE MICHIGAN DR NW # 3
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City | GRAND RAPIDS
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State | MI
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Zip | 49504-5831
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Country | US
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Telephone | 909-255-1753
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Fax | 760-227-5720
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A178050
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License Number State | CA
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