Provider Demographics
NPI:1649971839
Name:BOROKHOVICH, EMIL
Entity type:Individual
Prefix:
First Name:EMIL
Middle Name:
Last Name:BOROKHOVICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 W OLYMPIC BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4659
Mailing Address - Country:US
Mailing Address - Phone:213-804-5678
Mailing Address - Fax:
Practice Address - Street 1:5901 W OLYMPIC BLVD STE 103
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4659
Practice Address - Country:US
Practice Address - Phone:213-804-5678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA480897163W00000X
CA7819363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse