Provider Demographics
NPI:1861468290
Name:BORGARO, SUSAN R (PHD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:BORGARO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11445 E VIA LINDA
Mailing Address - Street 2:SUITE 2, PMB 473
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-2655
Mailing Address - Country:US
Mailing Address - Phone:602-300-1508
Mailing Address - Fax:602-277-5848
Practice Address - Street 1:300 W CLARENDON AVENUE
Practice Address - Street 2:SUITE 130
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3420
Practice Address - Country:US
Practice Address - Phone:602-300-1508
Practice Address - Fax:602-277-5848
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-25
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3457174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ105843Medicare ID - Type Unspecified