Healthcare Provider Details

I. General information

NPI: 1699809350
Provider Name (Legal Business Name): KRISTIN MARIE BORSACK M.S., C.G.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 MCCONNELL AVE
LOS ANGELES CA
90066-7026
US

IV. Provider business mailing address

900 PACIFIC COAST HWY UNIT 306
HUNTINGTON BEACH CA
92648-4858
US

V. Phone/Fax

Practice location:
  • Phone: 310-482-5576
  • Fax: 310-482-5600
Mailing address:
  • Phone: 818-470-7178
  • Fax: 714-849-3116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number2005033
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: