MEDICARE: ERICA BORGES

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	101YA0400X	Addiction (Substance Use Disorder) Counselor		CA
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1306230420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA BORGES

Provider Business Mailing Address
First Line	:	302 S E ST
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-5133
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 S E ST
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-5133
Country	:	US
Telephone Number	:	707-541-8378
Fax Number	:

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

Provider Enumeration Date	:	03/26/2015
Last Update Date	:	03/26/2015

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Directions to “ ERICA BORGES ” Practice Location

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