Provider Demographics
NPI:1225140429
Name:LABORDE, NILSA PATRITTI (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:NILSA
Middle Name:PATRITTI
Last Name:LABORDE
Suffix:
Gender:F
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 TORRANCE BLVD.
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-6004
Mailing Address - Country:US
Mailing Address - Phone:310-540-7599
Mailing Address - Fax:310-540-7579
Practice Address - Street 1:4201 TORRANCE BLVD STE 735
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4518
Practice Address - Country:US
Practice Address - Phone:310-540-7599
Practice Address - Fax:310-540-7579
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43912170100000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43912Medicare ID - Type Unspecified
CAF11035Medicare UPIN