Provider Demographics
NPI:1679354211
Name:BORGES, JOE
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:BORGES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19520 REXHAM CT
Mailing Address - Street 2:
Mailing Address - City:HILMAR
Mailing Address - State:CA
Mailing Address - Zip Code:95324-9047
Mailing Address - Country:US
Mailing Address - Phone:209-277-6253
Mailing Address - Fax:
Practice Address - Street 1:1500 MEREDITH AVE
Practice Address - Street 2:
Practice Address - City:GUSTINE
Practice Address - State:CA
Practice Address - Zip Code:95322-1701
Practice Address - Country:US
Practice Address - Phone:209-854-5030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist