1134359854 NPI number — JUAN PAOLO BORJA DO

Table of content: DR. GABRIEL S ALDEA M.D. (NPI 1952480758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134359854 NPI number — JUAN PAOLO BORJA DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORJA
Provider First Name:
JUAN
Provider Middle Name:
PAOLO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BORJA
Provider Other First Name:
PAOLO
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1134359854
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6355 S BUFFALO DR FL 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89113-2133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-216-3346
Provider Business Mailing Address Fax Number:
702-671-6883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4490 N RANCHO DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89130-3406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-655-0550
Provider Business Practice Location Address Fax Number:
702-655-0545
Provider Enumeration Date:
07/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  DO3047 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: OS 10650 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1908 . This is a "QUALITY HEALTH PLANS-LARGO OFFICE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1909 . This is a "QUALITY HEALTH PLANS-PASADENA OFFIE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P112544 . This is a "FREEDOM HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1134359854 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1907 . This is a "QUALITY HEALTH PLANS-49TH STREET OFFICE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: DO3047 . This is a "STATE LICENSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 201266825 . This is a "TRICARE-ALL LOCATIONS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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