Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | A029701 | CA |
NPI | 1851448484 |
---|---|
Provider Name | Dr. Bernard Deberry Borowiecki |
First Address | Irvine, CA 92618-3711 |
Second Address | Irvine, CA 92618-3711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A87269 | (02) | CA |