Provider Demographics
NPI:1114634888
Name:BORJA, CELINA QUIDACHAY (NCMA, CES, NOTARY)
Entity Type:Individual
Prefix:MRS
First Name:CELINA
Middle Name:QUIDACHAY
Last Name:BORJA
Suffix:
Gender:F
Credentials:NCMA, CES, NOTARY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 SE ELLSWORTH RD APT S200
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-6256
Mailing Address - Country:US
Mailing Address - Phone:360-334-0844
Mailing Address - Fax:
Practice Address - Street 1:1221 SE ELLSWORTH RD APT S200
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-6256
Practice Address - Country:US
Practice Address - Phone:360-334-0844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA793039363AM0700X
WA374U00000X
226000000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No374U00000XNursing Service Related ProvidersHome Health Aide
No226000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreational Therapist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2220212Medicaid