Provider Demographics
NPI:1669645081
Name:BORJA, MICHAEL D (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:BORJA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5905 SEVERIN DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3806
Mailing Address - Country:US
Mailing Address - Phone:619-589-2606
Mailing Address - Fax:619-464-0900
Practice Address - Street 1:2437 FENTON ST
Practice Address - Street 2:SUITE B
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-3517
Practice Address - Country:US
Practice Address - Phone:619-656-5176
Practice Address - Fax:619-656-5173
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 34595225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB217225Medicare PIN