Healthcare Provider Details

I. General information

NPI: 1659589026
Provider Name (Legal Business Name): ZACHALIS MAITE BORKOWSKI M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14444 BEACH BLVD
JACKSONVILLE FL
32250-2079
US

IV. Provider business mailing address

244 E BETONY BRANCH WAY
JACKSONVILLE FL
32259-4049
US

V. Phone/Fax

Practice location:
  • Phone: 904-858-7510
  • Fax:
Mailing address:
  • Phone: 904-230-1631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ4132
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: