Provider Demographics
NPI:1477100220
Name:BORZOUYEH POURSHARIF MD INC
Entity Type:Organization
Organization Name:BORZOUYEH POURSHARIF MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BORZOUYEH
Authorized Official - Middle Name:
Authorized Official - Last Name:POURSHARIF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-975-5575
Mailing Address - Street 1:1513 S GRAND AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3075
Mailing Address - Country:US
Mailing Address - Phone:213-262-1400
Mailing Address - Fax:213-262-1414
Practice Address - Street 1:1513 S GRAND AVE STE 300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3075
Practice Address - Country:US
Practice Address - Phone:213-262-1400
Practice Address - Fax:213-262-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty