Provider Demographics
NPI:1053717280
Name:BORREGO COMMUNITY HEALTH FOUNDATION
Entity type:Organization
Organization Name:BORREGO COMMUNITY HEALTH FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSSELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-344-2815
Mailing Address - Street 1:955 HARBOR ISLAND DR.
Mailing Address - Street 2:SUITE 155
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-1034
Mailing Address - Country:US
Mailing Address - Phone:619-344-2815
Mailing Address - Fax:
Practice Address - Street 1:955 HARBOR ISLAND DR
Practice Address - Street 2:SUITE 155
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-1069
Practice Address - Country:US
Practice Address - Phone:619-344-2815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1134144165Medicare PIN