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TATYANA V. BORODULIN MD INC NPI 1629153697


NPI Information

NPI: 1629153697
Provider Name: TATYANA V. BORODULIN MD, INC

Doing Business As: CAMPBELL FAMILY PRACTICE

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 05D2029739

Address:
1600 W CAMPBELL AVE
SUITE 202
CAMPBELL, CA
ZIP 95008
Phone: (408) 375-3300
Get Directions

TATYANA V. BORODULIN MD, INC is a family medicine in Campbell, CA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. TATYANA V. BORODULIN MD, INC NPI is 1629153697. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Campbell Family Practice.

The provider's business location address is:

1600 W CAMPBELL AVE
SUITE 202
CAMPBELL, CA
ZIP 95008-526
Phone: (408) 375-3300
Fax: (408) 378-6822

The provider's authorized official is Tatyana V Borodulin .
The authorized official title is Doctor and has the following contact phone number (408) 378-3330.

The CLIA number assigned to this NPI record is 05D2029739 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/26/2006 and was last updated on 3/4/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1ZZZ22056ZMEDICARE PINCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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