Provider Demographics
NPI:1679933113
Name:SIMONA BORZA PMHNP, LLC
Entity type:Organization
Organization Name:SIMONA BORZA PMHNP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIMONA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORZA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:503-805-7895
Mailing Address - Street 1:9600 SW OAK ST
Mailing Address - Street 2:SUITE 325
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6583
Mailing Address - Country:US
Mailing Address - Phone:503-805-7895
Mailing Address - Fax:509-935-5884
Practice Address - Street 1:9600 SW OAK ST
Practice Address - Street 2:SUITE 325
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6583
Practice Address - Country:US
Practice Address - Phone:503-805-7895
Practice Address - Fax:509-935-5884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200950102NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty