Provider Demographics
NPI:1306939038
Name:BORCK, VICKY K (DO)
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:K
Last Name:BORCK
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:135 S SIERRA AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1815
Mailing Address - Country:US
Mailing Address - Phone:161-929-4411
Mailing Address - Fax:161-929-5504
Practice Address - Street 1:7850 VISTA HILL AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2717
Practice Address - Country:US
Practice Address - Phone:619-294-4119
Practice Address - Fax:619-295-5044
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2017-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A112842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A11284OtherMEDICAL LICENSE
TX127427605Medicaid
G05512Medicare UPIN
CAHJ551AMedicare UPIN