Provider Demographics
NPI:1477868933
Name:BORBOR, SHARIAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARIAR
Middle Name:
Last Name:BORBOR
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 1:1014 BROADWAY # 617
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2808
Mailing Address - Country:US
Mailing Address - Phone:626-334-4061
Mailing Address - Fax:
Practice Address - Street 1:521 N AZUSA AVE
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-2936
Practice Address - Country:US
Practice Address - Phone:626-334-4061
Practice Address - Fax:626-334-6828
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA123079207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine