Provider Demographics
NPI:1174044341
Name:DE BORJA, CELINA FRANCESCA (MD)
Entity Type:Individual
Prefix:
First Name:CELINA FRANCESCA
Middle Name:
Last Name:DE BORJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 16TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2549
Mailing Address - Country:US
Mailing Address - Phone:415-353-2967
Mailing Address - Fax:
Practice Address - Street 1:319 LONGWOOD AVE STE 6
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5710
Practice Address - Country:US
Practice Address - Phone:857-218-4924
Practice Address - Fax:617-730-0683
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2019-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA162846208000000X, 2080S0010X
390200000X
MA2744782080S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program