Provider Demographics
NPI:1386144145
Name:BOROIAN, DEREK (ATC)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:BOROIAN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1952 W LA PALMA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-3544
Mailing Address - Country:US
Mailing Address - Phone:949-606-3555
Mailing Address - Fax:
Practice Address - Street 1:19301 WILLOW BROOK LN
Practice Address - Street 2:
Practice Address - City:TRABUCO CYN
Practice Address - State:CA
Practice Address - Zip Code:92679-1187
Practice Address - Country:US
Practice Address - Phone:949-606-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer