Healthcare Provider Details

I. General information

NPI: 1033162912
Provider Name (Legal Business Name): HARRIET BETH BOROFSKY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S SAN MATEO DR
SAN MATEO CA
94401-3805
US

IV. Provider business mailing address

500 REDWOOD BLVD STE 300
NOVATO CA
94947-6921
US

V. Phone/Fax

Practice location:
  • Phone: 650-696-4140
  • Fax:
Mailing address:
  • Phone: 415-884-3415
  • Fax: 415-883-0877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG689150
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: