Healthcare Provider Details

I. General information

NPI: 1972527380
Provider Name (Legal Business Name): PETER S BORDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23456 HAWTHORNE BLVD SUITE 200
TORRANCE CA
90505-4716
US

IV. Provider business mailing address

23456 HAWTHORNE BLVD SUITE 200
TORRANCE CA
90505-4716
US

V. Phone/Fax

Practice location:
  • Phone: 310-375-8700
  • Fax: 310-375-8776
Mailing address:
  • Phone: 310-375-8700
  • Fax: 310-375-8776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA62201
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: