Healthcare Provider Details

I. General information

NPI: 1982995015
Provider Name (Legal Business Name): NICHOLAS ALEXANDER BORJA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2011
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 NW 12TH AVE FL 1
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1501 NW 10TH AVENUE FLOOR 6, SUITE M860
MIAMI FL
33136-1012
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6006
  • Fax: 305-243-3919
Mailing address:
  • Phone: 305-243-6006
  • Fax: 305-243-3919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberME-137924
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: