Provider Demographics
NPI:1194065664
Name:BORGES DE MARTINEZ, ANA LIA
Entity type:Individual
Prefix:MRS
First Name:ANA
Middle Name:LIA
Last Name:BORGES DE MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 E TURQUOISE WAY
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-4009
Mailing Address - Country:US
Mailing Address - Phone:801-604-7925
Mailing Address - Fax:
Practice Address - Street 1:5814 S 900 E
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84121-1644
Practice Address - Country:US
Practice Address - Phone:385-800-3272
Practice Address - Fax:385-800-3260
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2023-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8339315-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist