MEDICARE: DR. RICHARD L BORREGO PH.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	103G00000X	Clinical Neuropsychologist	940	CO
2	103TC0700X	Clinical Psychologist	940	CO

General Provider Information

NPI Number	:	1437345816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD L BORREGO PH.D.

Provider Business Mailing Address
First Line	:	3540 S POPLAR ST STE 202
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80237-1362
Country	:	US
Telephone Number	:	303-850-7510
Fax Number	:	303-471-5901

Provider Business Practice Location Address
First Line	:	3540 S POPLAR ST STE 202
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80237-1362
Country	:	US
Telephone Number	:	303-850-7510
Fax Number	:	303-471-5901

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

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	09/19/2007

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