Healthcare Provider Details

I. General information

NPI: 1336777903
Provider Name (Legal Business Name): MAUNA EMILYN BORJA EDROZO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAUNA EMILYN EDROZO GATTENBY DO

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 HOSPITAL LOOP
FAIRCHILD AFB WA
99011-8704
US

IV. Provider business mailing address

701 HOSPITAL LOOP
FAIRCHILD AFB WA
99011-8704
US

V. Phone/Fax

Practice location:
  • Phone: 509-247-2361
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2846
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: