Provider Demographics
NPI:1356179634
Name:BORRAJO, MARIA C
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:C
Last Name:BORRAJO
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 1:479 CALABRIA AVE SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-4002
Mailing Address - Country:US
Mailing Address - Phone:305-772-1652
Mailing Address - Fax:
Practice Address - Street 1:479 CALABRIA AVE SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-4002
Practice Address - Country:US
Practice Address - Phone:305-772-1652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician