Individual
MR. JAMES BLEAK BORGQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CP
Contact information
Practice address
7921 PROFESSIONAL CIR, HUNTINGTON BEACH, CA 92648-1901
(714) 847-8751
(714) 847-8913
Mailing address
7921 PROFESSIONAL CIR, HUNTINGTON BEACH, CA 92648-1901
(714) 847-8751
(714) 847-8913
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
CP2925
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5441790001
PTAN
CA
01
—
XB0029250
MEDI-CAL
CA
01
—
ZZZ64903Z
BLUE SHIELD
CA
Enumeration date
08/02/2006
Last updated
04/05/2013
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