Provider Demographics
NPI:1093912495
Name:MARIANAS FOOTCARE CLINIC
Entity Type:Organization
Organization Name:MARIANAS FOOTCARE CLINIC
Other - Org Name:TERESA D BORJA, DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:DAMIAN
Authorized Official - Last Name:BORJA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM, BOARD CERTIFIED
Authorized Official - Phone:671-649-3338
Mailing Address - Street 1:122 TUN JOSE TOVES WAY
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913
Mailing Address - Country:US
Mailing Address - Phone:671-649-3338
Mailing Address - Fax:671-649-3336
Practice Address - Street 1:425 CHALAN SAN ANTONIO
Practice Address - Street 2:PMB 1021
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3602
Practice Address - Country:US
Practice Address - Phone:671-649-3338
Practice Address - Fax:671-649-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUPOD000005213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty