Provider Demographics
NPI:1619555711
Name:BORJA, CECILIA (NP)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:BORJA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E 5TH ST UNIT 11
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-3894
Mailing Address - Country:US
Mailing Address - Phone:310-753-1434
Mailing Address - Fax:
Practice Address - Street 1:750 E 5TH ST UNIT 11
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-3894
Practice Address - Country:US
Practice Address - Phone:310-753-1434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12291363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health