Healthcare Provider Details

I. General information

NPI: 1740456540
Provider Name (Legal Business Name): PETE BORBOA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16161 VENTURA BLVD STE 227
ENCINO CA
91436-2572
US

IV. Provider business mailing address

2159 W 20TH ST
LOS ANGELES CA
90018-1407
US

V. Phone/Fax

Practice location:
  • Phone: 818-788-2884
  • Fax: 818-788-0507
Mailing address:
  • Phone: 213-268-7499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC29722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: