Individual
SHANNON YVONNE BORREGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
483 W. SEED FARM RD, SACATON, AZ 85147
(602) 528-1200
Mailing address
PO BOX 38, SACATON, AZ 85147-0001
(602) 528-1200
(602) 528-1255
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1825
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
640201
—
AZ
Enumeration date
08/10/2011
Last updated
11/04/2015
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