Provider Demographics
NPI:1134359854
Name:BORJA, JUAN PAOLO (DO)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:PAOLO
Last Name:BORJA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:PAOLO
Other - Middle Name:
Other - Last Name:BORJA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:4490 N RANCHO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3406
Practice Address - Country:US
Practice Address - Phone:702-655-0550
Practice Address - Fax:702-655-0545
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO3047207Q00000X
FLOS 10650207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1908OtherQUALITY HEALTH PLANS-LARGO OFFICE
FL1909OtherQUALITY HEALTH PLANS-PASADENA OFFIE
FLP112544OtherFREEDOM HEALTH
NV1134359854Medicaid
FL1907OtherQUALITY HEALTH PLANS-49TH STREET OFFICE
NVDO3047OtherSTATE LICENSE
FL201266825OtherTRICARE-ALL LOCATIONS