Provider Demographics
NPI:1942506027
Name:GEORGE BORIS, M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:GEORGE BORIS, M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / M.D.
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BORIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-204-5822
Mailing Address - Street 1:9700 VENICE BLVD
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2717
Mailing Address - Country:US
Mailing Address - Phone:310-204-5822
Mailing Address - Fax:310-204-2477
Practice Address - Street 1:9700 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2717
Practice Address - Country:US
Practice Address - Phone:310-204-5822
Practice Address - Fax:310-204-2477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27267207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty