Provider Demographics
NPI:1306283791
Name:BORJA, CUAUHTEMOC (DDS)
Entity type:Individual
Prefix:
First Name:CUAUHTEMOC
Middle Name:
Last Name:BORJA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 JUAN SARABIA
Mailing Address - Street 2:
Mailing Address - City:TIJUANA
Mailing Address - State:BAJA CALIFORNIA
Mailing Address - Zip Code:22000
Mailing Address - Country:MX
Mailing Address - Phone:619-587-8938
Mailing Address - Fax:
Practice Address - Street 1:8950 JUAN SARABIA
Practice Address - Street 2:
Practice Address - City:TIJUANA
Practice Address - State:BAJA CA
Practice Address - Zip Code:22000
Practice Address - Country:MX
Practice Address - Phone:619-587-8938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-27
Last Update Date:2013-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ32136391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice