Basic Information
| Provider Information | |||||||||
| NPI: | 1669645081 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BORJA | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5905 SEVERIN DR | ||||||||
| Address2: | |||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919423806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195892606 | ||||||||
| FaxNumber: | 6194640900 | ||||||||
| Practice Location | |||||||||
| Address1: | 2437 FENTON ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919143517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196565176 | ||||||||
| FaxNumber: | 6196565173 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2008 | ||||||||
| LastUpdateDate: | 09/08/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT 34595 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.