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General NPI Number Information
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NPI Number | 1255148128
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Entity Type | Organization
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Legal Business Name | BOREALIS WOMEN'S SERVICES, PLLC
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Dates
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Enumeration Date | 12/14/2024
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Last Update Date | 12/14/2024
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Provider Practice Location Address
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Address Line | 200 VALLEY WOOD DR STE A200
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City | THE WOODLANDS
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State | TX
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Zip | 77380-3673
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Country | US
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Telephone | 832-446-0301
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Fax | 832-446-0302
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Provider Business Mailing Address
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Address Line | 3120 SOUTHWEST FWY STE 101 PMB 279433
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City | HOUSTON
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State | TX
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Zip | 77098
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Country | US
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Telephone | 831-446-0301
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Fax | 832-446-0302
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | BOREL FONHOUE
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Credential | MD
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Telephone | 801-719-4224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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