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General NPI Number Information
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NPI Number | 1487968509
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Entity Type | Organization
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Legal Business Name | LAWRENCE N BORELLI, M.D.
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Dates
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Enumeration Date | 07/30/2010
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Last Update Date | 06/23/2011
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Provider Practice Location Address
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Address Line | 1220 LA VENTA DR SUITE 201
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-3703
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Country | US
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Telephone | 805-381-1953
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Fax | 805-381-1079
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Provider Business Mailing Address
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Address Line | 1220 LA VENTA DR SUITE 201
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-3703
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Country | US
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Telephone | 805-381-1953
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Fax | 805-381-1079
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. NICHELLE CHRISTINE VASQUEZ
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Credential |
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Telephone | 805-381-1953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G25506
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License Number State | CA
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