Basic Information
| Provider Information | |||||||||
| NPI: | 1073505327 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BORDOFSKY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 E MICHELTORENA ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931032257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055633234 | ||||||||
| FaxNumber: | 8055633130 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 E MICHELTORENA ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931032257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055633234 | ||||||||
| FaxNumber: | 8055633130 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2005 | ||||||||
| LastUpdateDate: | 09/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | G75364 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110138625 | 01 | CA | RAILROAD MEDICARE | OTHER | 00G753640 | 05 | CA | MEDICAID |