Healthcare Provider Details

I. General information

NPI: 1942506027
Provider Name (Legal Business Name): GEORGE BORIS, M.D. A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 VENICE BLVD
CULVER CITY CA
90232-2717
US

IV. Provider business mailing address

9700 VENICE BLVD
CULVER CITY CA
90232-2717
US

V. Phone/Fax

Practice location:
  • Phone: 310-204-5822
  • Fax: 310-204-2477
Mailing address:
  • Phone: 310-204-5822
  • Fax: 310-204-2477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberG27267
License Number StateCA

VIII. Authorized Official

Name: GEORGE BORIS
Title or Position: OWNER / M.D.
Credential: M.D.
Phone: 310-204-5822