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General NPI Number Information
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NPI Number | 1225667132
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Entity Type | Individual
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Provider Name | THOMAS ALAN BORAGNO PHARM D
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Gender | Male
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Dates
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Enumeration Date | 04/02/2020
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Last Update Date | 04/02/2020
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Provider Practice Location Address
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Address Line | 716 E BALBOA BLVD
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City | NEWPORT BEACH
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State | CA
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Zip | 92661-1306
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Country | US
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Telephone | 949-673-5370
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Fax |
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Provider Business Mailing Address
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Address Line | 460 E 16TH ST
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City | COSTA MESA
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State | CA
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Zip | 92627-3266
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Country | US
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Telephone | 949-689-7731
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Fax |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 35445
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License Number State | CA
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