Basic Information
| Provider Information | |||||||||
| NPI: | 1184012866 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BORREGO | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | ELENA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 719 MAHOGANY DR | ||||||||
| Address2: | |||||||||
| City: | EL CAJON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920192629 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4094 4TH AVE | ||||||||
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| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921032143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195152545 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2015 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 444666 | CA | N | Nursing Service Providers | Registered Nurse | 390200000X | 444666 | CA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 363LP0808X | NP95005019 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.