Provider Demographics
NPI:1295834927
Name:BORDAS, JULIO JACINTO (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIO
Middle Name:JACINTO
Last Name:BORDAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12739 LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-4521
Mailing Address - Country:US
Mailing Address - Phone:805-881-3803
Mailing Address - Fax:866-268-5736
Practice Address - Street 1:12739 LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-4521
Practice Address - Country:US
Practice Address - Phone:805-881-3803
Practice Address - Fax:866-268-5736
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55479207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G554790Medicaid
CA00G554790Medicaid