Provider Demographics
NPI:1255148128
Name:BOREALIS WOMEN'S SERVICES, PLLC
Entity type:Organization
Organization Name:BOREALIS WOMEN'S SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOREL
Authorized Official - Middle Name:
Authorized Official - Last Name:FONHOUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-719-4224
Mailing Address - Street 1:3120 SOUTHWEST FWY
Mailing Address - Street 2:STE 101 PMB 279433
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098
Mailing Address - Country:US
Mailing Address - Phone:831-446-0301
Mailing Address - Fax:832-446-0302
Practice Address - Street 1:200 VALLEY WOOD DR STE A200
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3673
Practice Address - Country:US
Practice Address - Phone:832-446-0301
Practice Address - Fax:832-446-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-14
Last Update Date:2024-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty