MEDICARE: DR. MARK JAMES BORIGINI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	G67619	CA

General Provider Information

NPI Number	:	1043257082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK JAMES BORIGINI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 667
Second Line	:
City	:	LOMITA
State	:	CA
Zip	:	90717-0667
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7601 IMPERIAL HWY
Second Line	:
City	:	DOWNEY
State	:	CA
Zip	:	90242-3456
Country	:	US
Telephone Number	:	562-221-1681
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	07/08/2007

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