Healthcare Provider Details

I. General information

NPI: 1174044341
Provider Name (Legal Business Name): CELINA FRANCESCA DE BORJA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 08/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 LONGWOOD AVE STE 6
BOSTON MA
02115-5710
US

IV. Provider business mailing address

550 16TH ST
SAN FRANCISCO CA
94143-2549
US

V. Phone/Fax

Practice location:
  • Phone: 857-218-4924
  • Fax: 617-730-0683
Mailing address:
  • Phone: 415-353-2967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA162846
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License NumberA162846
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number274478
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: