Healthcare Provider Details

I. General information

NPI: 1528995099
Provider Name (Legal Business Name): CHERYL BORJA ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 CRAVEN ST
SAN DIEGO CA
92136-5599
US

IV. Provider business mailing address

2450 CRAVEN ST
SAN DIEGO CA
92136-5599
US

V. Phone/Fax

Practice location:
  • Phone: 619-556-8096
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number070502189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: