Provider Demographics
NPI:1700944600
Name:BORODKIN, ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:BORODKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 PONY LANE
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-4123
Mailing Address - Country:US
Mailing Address - Phone:310-377-8851
Mailing Address - Fax:
Practice Address - Street 1:927 DEEP VALLEY DRIVE
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-4123
Practice Address - Country:US
Practice Address - Phone:310-541-2542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2017-11-21
Deactivation Date:2015-11-10
Deactivation Code:
Reactivation Date:2017-11-21
Provider Licenses
StateLicense IDTaxonomies
CAA183022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA18302OtherSTATE LICENSE