Provider Demographics
NPI:1467667824
Name:BORLIK, MARCY FORGEY (MD, MPH)
Entity type:Individual
Prefix:
First Name:MARCY
Middle Name:FORGEY
Last Name:BORLIK
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 MOSSBANK DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-2113
Mailing Address - Country:US
Mailing Address - Phone:312-285-9093
Mailing Address - Fax:
Practice Address - Street 1:10323 SANTA MONICA BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5056
Practice Address - Country:US
Practice Address - Phone:213-373-1070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2225812084P0800X
CAA999952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABW067ZMedicare PIN