Healthcare Provider Details

I. General information

NPI: 1679990071
Provider Name (Legal Business Name): LAUREN BORETA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 DIVISADERO ST
SAN FRANCISCO CA
94143-3010
US

IV. Provider business mailing address

1600 DIVISADERO ST
SAN FRANCISCO CA
94143-3010
US

V. Phone/Fax

Practice location:
  • Phone: 415-443-0283
  • Fax:
Mailing address:
  • Phone: 415-443-0283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberA138986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: