Provider Demographics
NPI:1215264668
Name:BORJA, GREGORIO ANTONIO
Entity type:Individual
Prefix:
First Name:GREGORIO
Middle Name:ANTONIO
Last Name:BORJA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DVA CBOC GUAM U.S. NAVAL HOSPITAL, BLDG I, E200
Mailing Address - Street 2:P.O. BOX 7608
Mailing Address - City:AGANA HEIGHTS
Mailing Address - State:GU
Mailing Address - Zip Code:96919-1600
Mailing Address - Country:US
Mailing Address - Phone:671-344-7423
Mailing Address - Fax:671-472-7249
Practice Address - Street 1:117 SAN VICENTE DR
Practice Address - Street 2:
Practice Address - City:BARRIGADA
Practice Address - State:GU
Practice Address - Zip Code:96913-1130
Practice Address - Country:US
Practice Address - Phone:671-344-7423
Practice Address - Fax:671-472-7249
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker