Healthcare Provider Details

I. General information

NPI: 1952506982
Provider Name (Legal Business Name): MARY CHARLENE BORJA RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 LEXINGTON AVE
EL MONTE CA
91731-2608
US

IV. Provider business mailing address

681 W BOYD CT
UPLAND CA
91786-2755
US

V. Phone/Fax

Practice location:
  • Phone: 626-453-3762
  • Fax:
Mailing address:
  • Phone: 909-985-8348
  • Fax: 626-444-6834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number293410
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: