Provider Demographics
NPI:1740456540
Name:BORBOA, PETE (DC)
Entity type:Individual
Prefix:DR
First Name:PETE
Middle Name:
Last Name:BORBOA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2159 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-1407
Mailing Address - Country:US
Mailing Address - Phone:213-268-7499
Mailing Address - Fax:
Practice Address - Street 1:16161 VENTURA BLVD STE 227
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2572
Practice Address - Country:US
Practice Address - Phone:818-788-2884
Practice Address - Fax:818-788-0507
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29722111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation