Provider Demographics
NPI:1487968509
Name:LAWRENCE N BORELLI, M.D.
Entity type:Organization
Organization Name:LAWRENCE N BORELLI, M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NICHELLE
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-381-1953
Mailing Address - Street 1:1220 LA VENTA DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3703
Mailing Address - Country:US
Mailing Address - Phone:805-381-1953
Mailing Address - Fax:805-381-1079
Practice Address - Street 1:1220 LA VENTA DR
Practice Address - Street 2:SUITE 201
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3703
Practice Address - Country:US
Practice Address - Phone:805-381-1953
Practice Address - Fax:805-381-1079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25506174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG25506OtherSTATE LICENSE
CAG25506BOtherMEDICARE PTAN #
CAA42694OtherUPIN
CAA42694OtherUPIN