Provider Demographics
NPI:1932756301
Name:BORJA, MARY REYES X
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:REYES
Last Name:BORJA
Suffix:X
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8398
Mailing Address - Street 2:
Mailing Address - City:AGAT
Mailing Address - State:GU
Mailing Address - Zip Code:96928-1398
Mailing Address - Country:US
Mailing Address - Phone:671-487-6822
Mailing Address - Fax:
Practice Address - Street 1:412A NIMITZ BEACH, RT 2
Practice Address - Street 2:
Practice Address - City:AGAT
Practice Address - State:GU
Practice Address - Zip Code:96928
Practice Address - Country:US
Practice Address - Phone:671-989-5071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care