Provider Demographics
NPI:1447591599
Name:BORMANIS, PETERIS (MD)
Entity Type:Individual
Prefix:MR
First Name:PETERIS
Middle Name:
Last Name:BORMANIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:BORMANIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4933 MATULA DR
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4005
Mailing Address - Country:US
Mailing Address - Phone:818-344-6939
Mailing Address - Fax:
Practice Address - Street 1:4933 MATULA DR
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4005
Practice Address - Country:US
Practice Address - Phone:818-344-6939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGFE23035208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery