Healthcare Provider Details

I. General information

NPI: 1730963224
Provider Name (Legal Business Name): JUSTIN NAPUTI BORJA IDHS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 08/24/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VICTOR WHARF PIER 3
SANTA RITA GU
96915
US

IV. Provider business mailing address

316 CHANDIHA STREET
DEDEDO GU
96929
US

V. Phone/Fax

Practice location:
  • Phone: 931-338-6737
  • Fax:
Mailing address:
  • Phone: 931-338-6737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: