Provider Demographics
NPI:1902147887
Name:BORREGO, MATTHEW E (PHD, MS, RPH)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:E
Last Name:BORREGO
Suffix:
Gender:M
Credentials:PHD, MS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5315 PALAZZO RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-3871
Mailing Address - Country:US
Mailing Address - Phone:505-272-5945
Mailing Address - Fax:
Practice Address - Street 1:1397 WEIMER RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6253
Practice Address - Country:US
Practice Address - Phone:575-737-3377
Practice Address - Fax:575-737-3339
Is Sole Proprietor?:No
Enumeration Date:2013-03-03
Last Update Date:2013-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5146183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist