Provider Demographics
NPI:1588972442
Name:BORJA, IMELDA ANCHETA (PA-C)
Entity type:Individual
Prefix:MS
First Name:IMELDA
Middle Name:ANCHETA
Last Name:BORJA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1837 E 215TH PL
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-1857
Mailing Address - Country:US
Mailing Address - Phone:310-549-7341
Mailing Address - Fax:
Practice Address - Street 1:22844 VIRGINIA BLVD
Practice Address - Street 2:
Practice Address - City:CALIFORNIA CITY
Practice Address - State:CA
Practice Address - Zip Code:93505
Practice Address - Country:US
Practice Address - Phone:760-373-1764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19669363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical