Provider Demographics
NPI:1033175815
Name:BORIA, FAUSTO (MD)
Entity Type:Individual
Prefix:
First Name:FAUSTO
Middle Name:
Last Name:BORIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-0249
Mailing Address - Country:US
Mailing Address - Phone:787-746-3035
Mailing Address - Fax:787-286-5974
Practice Address - Street 1:CARR 189 KM 3.5
Practice Address - Street 2:SECTOR HERETER
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-746-3035
Practice Address - Fax:787-286-5974
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7009208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
6240042OtherHUMANA
27009OtherCIGNA
600899OtherMMM HEALTHCARE
18635OtherPROSSAM
PE1680OtherPALIC
067158OtherCRUZ AZUL DE PR
223047OtherPREFERRED HEALTH
2604OtherAMERICAN HEALTH
29028OtherTRIPLE S
N241OtherFIRST MEDICAL
29028OtherTRIPLE S