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General NPI Number Information
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NPI Number | 1588972442
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Entity Type | Individual
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Provider Name | IMELDA ANCHETA BORJA PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/14/2010
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Last Update Date | 09/14/2010
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Provider Practice Location Address
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Address Line | 22844 VIRGINIA BLVD
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City | CALIFORNIA CITY
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State | CA
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Zip | 93505
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Country | US
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Telephone | 760-373-1764
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Fax |
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Provider Business Mailing Address
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Address Line | 1837 E 215TH PL
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City | CARSON
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State | CA
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Zip | 90745-1857
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Country | US
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Telephone | 310-549-7341
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA19669
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License Number State | CA
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