Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E1970 | CA |
Y | 222Z00000X | Podiatrist | E1970 | CA |
NPI | 1023029360 |
---|---|
Provider Name | Joseph Irving Borden |
First Address | Reseda, CA 91335-6308 |
Second Address | Reseda, CA 91335-6308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 10/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E19701 | (05) | CA |
T19154 | (02) | CA |