Healthcare Provider Details

I. General information

NPI: 1215393434
Provider Name (Legal Business Name): MICHAEL BOURDAA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N PERRIS BLVD
PERRIS CA
92571-2701
US

IV. Provider business mailing address

8027 N CEDAR AVE
FRESNO CA
93720-4827
US

V. Phone/Fax

Practice location:
  • Phone: 951-940-9190
  • Fax: 951-657-0526
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number74235
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: