1215264668 NPI number — GREGORIO ANTONIO BORJA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215264668 NPI number — GREGORIO ANTONIO BORJA

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215264668
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DVA CBOC GUAM U.S. NAVAL HOSPITAL, BLDG I, E200
Provider Second Line Business Mailing Address:
P.O. BOX 7608
Provider Business Mailing Address City Name:
AGANA HEIGHTS
Provider Business Mailing Address State Name:
GU
Provider Business Mailing Address Postal Code:
96919-1600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
671-344-7423
Provider Business Mailing Address Fax Number:
671-472-7249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 SAN VICENTE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARRIGADA
Provider Business Practice Location Address State Name:
GU
Provider Business Practice Location Address Postal Code:
96913-1130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
671-344-7423
Provider Business Practice Location Address Fax Number:
671-472-7249
Provider Enumeration Date:
11/05/2009

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: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com