Provider Demographics
NPI:1528265402
Name:BORROMEO, CARMELA (PT)
Entity type:Individual
Prefix:
First Name:CARMELA
Middle Name:
Last Name:BORROMEO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 CAMPUS DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1527
Mailing Address - Country:US
Mailing Address - Phone:949-999-3600
Mailing Address - Fax:949-769-8996
Practice Address - Street 1:1401 N TUSTIN AVE
Practice Address - Street 2:SUITE 360
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8644
Practice Address - Country:US
Practice Address - Phone:949-999-3631
Practice Address - Fax:949-999-8371
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2013-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist