MEDICARE: MS. JOVANNA BORQUEZ M.S

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	106H00000X	Marriage & Family Therapist	116480	CA

General Provider Information

NPI Number	:	1891246740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOVANNA BORQUEZ M.S

Provider Business Mailing Address
First Line	:	484 S GAGE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90063-1523
Country	:	US
Telephone Number	:	310-409-5854
Fax Number	:

Provider Business Practice Location Address
First Line	:	484 S GAGE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90063-1523
Country	:	US
Telephone Number	:	310-409-5854
Fax Number	:

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

Provider Enumeration Date	:	10/16/2016
Last Update Date	:	11/01/2021

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