Provider Demographics
NPI:1740435502
Name:OPTUM PALOS VERDES
Entity type:Organization
Organization Name:OPTUM PALOS VERDES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BORSOOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-326-8600
Mailing Address - Street 1:25210 CRENSHAW BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6134
Mailing Address - Country:US
Mailing Address - Phone:310-602-2700
Mailing Address - Fax:310-602-2789
Practice Address - Street 1:25210 CRENSHAW BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6134
Practice Address - Country:US
Practice Address - Phone:310-602-2700
Practice Address - Fax:310-602-2789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty