Provider Demographics
NPI:1710083761
Name:BORELLI, LAWRENCE NAPOLEON (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:NAPOLEON
Last Name:BORELLI
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 1:1220 LA VENTA DR
Mailing Address - Street 2:STE 201
Mailing Address - City:WESTLAKE VLG
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3703
Mailing Address - Country:US
Mailing Address - Phone:805-381-1953
Mailing Address - Fax:805-381-1079
Practice Address - Street 1:1220 LA VENTA DR
Practice Address - Street 2:STE 201
Practice Address - City:WESTLAKE VLG
Practice Address - State:CA
Practice Address - Zip Code:91361-3703
Practice Address - Country:US
Practice Address - Phone:805-381-1953
Practice Address - Fax:805-381-1079
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25506207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG25506BOtherMEDICARE PTAN
A42694Medicare UPIN