Individual
ANDREW S BORAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1764 MEADOW VALE DR, SOUTH LAKE TAHOE, CA 96150-4929
(802) 318-2717
Mailing address
1764 MEADOW VALE DR, SOUTH LAKE TAHOE, CA 96150-4929
(802) 318-2717
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000008263
BOC
CA
Enumeration date
02/19/2015
Last updated
02/19/2015
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