Healthcare Provider Details

I. General information

NPI: 1689739732
Provider Name (Legal Business Name): BORIS PILCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SANTA ROSA ST SUITE 201
SAN LUIS OBISPO CA
93405-5825
US

IV. Provider business mailing address

PO BOX 4659
SAN LUIS OBISPO CA
93403-4659
US

V. Phone/Fax

Practice location:
  • Phone: 805-782-8132
  • Fax: 805-597-8350
Mailing address:
  • Phone: 805-782-8132
  • Fax: 805-597-8350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG68397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: