Provider Demographics
NPI:1144230558
Name:BORGIA, DANIELA (PA)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:BORGIA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 W WASHINGTON ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-3829
Mailing Address - Country:US
Mailing Address - Phone:775-883-3953
Mailing Address - Fax:775-885-2785
Practice Address - Street 1:550 W WASHINGTON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-3829
Practice Address - Country:US
Practice Address - Phone:775-883-3953
Practice Address - Fax:775-885-2785
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA780363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002013067Medicaid
NV002013067Medicaid
NVP54080Medicare UPIN