Provider Demographics
NPI:1194491456
Name:BORJA, TATIANA JENINE PEREZ
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:JENINE PEREZ
Last Name:BORJA
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 1:50 VEVAU ST APT 308
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-1663
Mailing Address - Country:US
Mailing Address - Phone:808-385-3730
Mailing Address - Fax:
Practice Address - Street 1:3700 KEHALANI MAUKA PKWY
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-3559
Practice Address - Country:US
Practice Address - Phone:808-727-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist