Provider Demographics
NPI:1225592553
Name:BORDEN, MARIA SOCORRO BUENVIAJE
Entity Type:Individual
Prefix:
First Name:MARIA SOCORRO
Middle Name:BUENVIAJE
Last Name:BORDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAISY
Other - Middle Name:BUENVIAJE
Other - Last Name:BORDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1585 RIDGEVIEW TER
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3386
Mailing Address - Country:US
Mailing Address - Phone:573-692-6815
Mailing Address - Fax:
Practice Address - Street 1:1585 RIDGEVIEW TER
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3386
Practice Address - Country:US
Practice Address - Phone:573-692-6815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer