Provider Demographics
NPI:1083607667
Name:BORNFLETH, BRUCE ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALAN
Last Name:BORNFLETH
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:151 S SUNRISE WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-0118
Mailing Address - Country:US
Mailing Address - Phone:760-969-7770
Mailing Address - Fax:760-969-7771
Practice Address - Street 1:151 S SUNRISE WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-0118
Practice Address - Country:US
Practice Address - Phone:760-969-7770
Practice Address - Fax:760-969-7771
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA88125207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVA0000Medicare UPIN