Healthcare Provider Details

I. General information

NPI: 1700944600
Provider Name (Legal Business Name): ROBERT BORODKIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 11/21/2017
Certification Date:
Deactivation Date: 11/10/2015
Reactivation Date: 11/21/2017

III. Provider practice location address

927 DEEP VALLEY DRIVE
ROLLING HILLS ESTATES CA
90274-4123
US

IV. Provider business mailing address

24 PONY LANE
ROLLING HILLS ESTATES CA
90274-4123
US

V. Phone/Fax

Practice location:
  • Phone: 310-541-2542
  • Fax:
Mailing address:
  • Phone: 310-377-8851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA18302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: