Provider Demographics
NPI:1235456062
Name:BORJAS, LILLIAN IRENE (MA57688)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:IRENE
Last Name:BORJAS
Suffix:
Gender:F
Credentials:MA57688
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 W COLUMBUS DR STE 204
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1858
Mailing Address - Country:US
Mailing Address - Phone:813-872-7120
Mailing Address - Fax:
Practice Address - Street 1:3434 W COLUMBUS DR STE 204
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1858
Practice Address - Country:US
Practice Address - Phone:813-872-7120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA57688225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist