Basic Information
| Provider Information | |||||||||
| NPI: | 1538552831 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BORJA | ||||||||
| FirstName: | VANESSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9220 TELEGRAPH RD APT 223 | ||||||||
| Address2: | |||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902402451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5625654738 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9101 WHITTIER BLVD | ||||||||
| Address2: | |||||||||
| City: | PICO RIVERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906602405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628014626 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2015 | ||||||||
| LastUpdateDate: | 03/10/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 167G00000X | PT37906 | CA | Y | Nursing Service Providers | Licensed Psychiatric Technician |
No ID Information.