Individual
DR. MANUEL BORJA GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
801 S ADAMS ST, LABORATORY, PETERSBURG, VA 23803-5149
(804) 862-5010
Mailing address
801 S ADAMS ST, LABORATORY, PETERSBURG, VA 23803-5149
(804) 862-5010
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
0101026717
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015388
BCBS
VA
05
—
6680241
—
VA
Enumeration date
10/11/2006
Last updated
11/12/2007
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