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General NPI Number Information
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NPI Number | 1780738443
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Entity Type | Organization
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Legal Business Name | BORACCHIA & ASSOCIATES
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3920 CYPRESS DR
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City | PETALUMA
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State | CA
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Zip | 94954-5694
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Country | US
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Telephone | 707-765-3100
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Fax | 707-776-2682
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Provider Business Mailing Address
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Address Line | 3920 CYPRESS DR
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City | PETALUMA
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State | CA
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Zip | 94954-5694
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Country | US
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Telephone | 707-765-3100
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Fax | 707-776-2682
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Authorized Official
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Title or Position | CEO
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Name | MR. EDWARD J BORACCHIA
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Credential |
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Telephone | 707-765-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | SRJH27710545
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License Number State | CA
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