MEDICARE: BORINA NOU GARCIA LCSW

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	1041C0700X	Clinical Social Worker	98305	CA

General Provider Information

NPI Number	:	1851981914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BORINA NOU GARCIA LCSW

Provider Business Mailing Address
First Line	:	PO BOX 5213
Second Line	:
City	:	BELLFLOWER
State	:	CA
Zip	:	90707-5213
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3711 LONG BEACH BLVD STE 5015
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3315
Country	:	US
Telephone Number	:	562-964-6011
Fax Number	:

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

Provider Enumeration Date	:	01/22/2021
Last Update Date	:	01/22/2021

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