Provider Demographics
NPI:1952581647
Name:MARIA ELENA HERNANDEZ BORJAS MD PA
Entity Type:Organization
Organization Name:MARIA ELENA HERNANDEZ BORJAS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:HERNANDEZ BORJAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-242-4816
Mailing Address - Street 1:PO BOX 120373
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34712-0373
Mailing Address - Country:US
Mailing Address - Phone:352-242-4816
Mailing Address - Fax:352-242-4702
Practice Address - Street 1:364 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-3022
Practice Address - Country:US
Practice Address - Phone:352-242-4816
Practice Address - Fax:352-242-4702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85427207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57875Medicare PIN