Kelly Fons Borman, NP
Nurse Practitioner, Pediatrics in Los Angeles, CA. Individual provider (NPI-1).
NPI number1982004792
StatusActive
Last updated in NPPESJun 18, 2015
Details
- NPI
- 1982004792
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Kelly Fons Borman
- Credential
- NP
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Aug 28, 2014
- Last updated
- Jun 18, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0200X | Nurse Practitioner, Pediatrics | 21393 | CA | Yes |
| 163W00000X | Registered Nurse | 740170 | CA |
Practice location
4650 W Sunset Blvd # 54Los Angeles, CA 90027-6062
Phone 323-361-7844 · Fax 323-361-8767
Mailing address
4249 Stern AveSherman Oaks, CA 91423-4226
Phone 248-762-1963
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