Provider Demographics
NPI:1326266222
Name:BORRAS, ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:
Last Name:BORRAS
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 1:1151 W 6TH ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1828
Mailing Address - Country:US
Mailing Address - Phone:213-975-9328
Mailing Address - Fax:213-975-9328
Practice Address - Street 1:2010 WILSHIRE BLVD
Practice Address - Street 2:SUITE 612
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3507
Practice Address - Country:US
Practice Address - Phone:213-484-2912
Practice Address - Fax:213-484-2912
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC30475208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
B50654Medicare UPIN