Provider Demographics
NPI:1497476600
Name:BORESOFF, KARIN
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:
Last Name:BORESOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11518 FLOSSMOOR RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-3104
Mailing Address - Country:US
Mailing Address - Phone:562-743-5031
Mailing Address - Fax:
Practice Address - Street 1:5509 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-1301
Practice Address - Country:US
Practice Address - Phone:562-538-6053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL9739174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty