Provider Demographics
NPI:1558338509
Name:BORJA, TERESA DAMIAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:DAMIAN
Last Name:BORJA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:TERESA
Other - Middle Name:A
Other - Last Name:DAMIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 7702
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931
Mailing Address - Country:US
Mailing Address - Phone:671-649-3338
Mailing Address - Fax:671-649-3336
Practice Address - Street 1:122 TUN JOSE TOVES WAY
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3507
Practice Address - Country:US
Practice Address - Phone:671-649-3338
Practice Address - Fax:671-649-3336
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2015-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUPOD000005213ES0131X
GUPOD-05213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU4297580001Medicare NSC
GUH54078Medicare PIN
GU65D0912484Medicare ID - Type UnspecifiedCLIA NUMBER
GUU87980Medicare UPIN
GU54078Medicare ID - Type UnspecifiedPROVIDER NUMBER