MEDICARE: MRS. MARY CHARLENE BORJA RNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	293410	CA

General Provider Information

NPI Number	:	1952506982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY CHARLENE BORJA RNP

Provider Business Mailing Address
First Line	:	681 W BOYD CT
Second Line	:
City	:	UPLAND
State	:	CA
Zip	:	91786-2755
Country	:	US
Telephone Number	:	909-985-8348
Fax Number	:	626-444-6834

Provider Business Practice Location Address
First Line	:	3540 LEXINGTON AVE
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91731-2608
Country	:	US
Telephone Number	:	626-453-3762
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	07/08/2007

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