Provider Demographics
NPI:1548473507
Name:BORSO, MAYA GAYLYN (MD)
Entity type:Individual
Prefix:DR
First Name:MAYA
Middle Name:GAYLYN
Last Name:BORSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6256 GREENWICH DR STE 150
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5965
Mailing Address - Country:US
Mailing Address - Phone:858-658-6500
Mailing Address - Fax:866-558-4329
Practice Address - Street 1:6256 GREENWICH DR STE 150
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-5965
Practice Address - Country:US
Practice Address - Phone:858-658-6500
Practice Address - Fax:866-558-4329
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA971342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A971340OtherBS OF CA
CA1548473507Medicaid
CABY074UMedicare PIN
CA1548473507Medicaid
CA00A971340OtherBS OF CA