Healthcare Provider Details

I. General information

NPI: 1033463898
Provider Name (Legal Business Name): PETER S BORDEN MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 11/01/2012
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 Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA62201
License Number StateCA

VIII. Authorized Official

Name: PETER SCOTT BORDEN
Title or Position: OWNER
Credential: MD
Phone: 310-375-8700