Provider Demographics
NPI:1407884562
Name:BORUT, DANIELLE L (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:L
Last Name:BORUT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 CESAR E. CHAVEZ AVE
Mailing Address - Street 2:SUITE 532
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033
Mailing Address - Country:US
Mailing Address - Phone:323-987-1200
Mailing Address - Fax:323-987-1212
Practice Address - Street 1:1700 E CESAR E CHAVEZ AVE
Practice Address - Street 2:SUITE 3000
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2424
Practice Address - Country:US
Practice Address - Phone:323-987-1200
Practice Address - Fax:323-987-1212
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG19737208000000X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA90609Medicare UPIN