Provider Demographics
NPI:1689907420
Name:BORGES, GLADYS (MS, LD/N)
Entity Type:Individual
Prefix:MS
First Name:GLADYS
Middle Name:
Last Name:BORGES
Suffix:
Gender:F
Credentials:MS, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12110 TASHA CT
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-1844
Mailing Address - Country:US
Mailing Address - Phone:352-521-1450
Mailing Address - Fax:
Practice Address - Street 1:13941 15TH STREET
Practice Address - Street 2:PCHD WIC & NUTRITION SERVICES
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525
Practice Address - Country:US
Practice Address - Phone:352-521-1450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5003133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist