Healthcare Provider Details

I. General information

NPI: 1639675697
Provider Name (Legal Business Name): MRS. VICTORIA MARY BORDAYO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VICTORIA MARY ROMAN

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 PICKWICK PL
LANSING MI
48917-1788
US

IV. Provider business mailing address

3411 PICKWICK PL
LANSING MI
48917-1788
US

V. Phone/Fax

Practice location:
  • Phone: 517-455-3055
  • Fax:
Mailing address:
  • Phone: 517-455-3055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: