Provider Demographics
NPI:1629277835
Name:DANIEL B BORENSTEIN, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DANIEL B BORENSTEIN, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:BORENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-472-7386
Mailing Address - Street 1:151 N CANYON VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-2721
Mailing Address - Country:US
Mailing Address - Phone:310-472-7386
Mailing Address - Fax:310-471-0708
Practice Address - Street 1:151 N CANYON VIEW DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-2721
Practice Address - Country:US
Practice Address - Phone:310-472-7386
Practice Address - Fax:310-471-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0669733261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty