Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | G19737 | CA |
N | 2080P0205X | Pediatric Endocrinologist | G19737 | CA |
NPI | 1407884562 |
---|---|
Provider Name | Dr. Danielle L Borut |
First Address | Los Angeles, CA 90033 |
Second Address | Los Angeles, CA 90033-2424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 24/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A90609 | (02) | CA |