Individual
BARRY J BORM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4650 LINCOLN BLVD, MARINA DEL REY, CA 90292
(310) 823-8911
Mailing address
PO BOX 10550, WESTMINSTER, CA 92685-0550
(562) 809-3555
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
G73012
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G730120
—
CA
Enumeration date
09/03/2006
Last updated
05/02/2008
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