Provider Demographics
NPI:1881323863
Name:BORUKHOVA, ANGELINA (OD)
Entity type:Individual
Prefix:DR
First Name:ANGELINA
Middle Name:
Last Name:BORUKHOVA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SW 96TH TER APT 204
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2339
Mailing Address - Country:US
Mailing Address - Phone:347-972-8640
Mailing Address - Fax:
Practice Address - Street 1:6000 GLADES RD STE 1116
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7294
Practice Address - Country:US
Practice Address - Phone:561-367-1077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC6080152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist