Provider Demographics
NPI:1730535584
Name:RICHARD G BORQUEZ
Entity type:Organization
Organization Name:RICHARD G BORQUEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:BORQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-277-0606
Mailing Address - Street 1:911 HAMPSHIRE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WESTLAKE VLG
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2818
Mailing Address - Country:US
Mailing Address - Phone:805-277-0606
Mailing Address - Fax:805-253-1940
Practice Address - Street 1:911 HAMPSHIRE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WESTLAKE VLG
Practice Address - State:CA
Practice Address - Zip Code:91361-2818
Practice Address - Country:US
Practice Address - Phone:805-277-0606
Practice Address - Fax:805-253-1940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27731332BC3200X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty