Provider Demographics
NPI:1144888348
Name:BORYS GVOZDYEV MD A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:BORYS GVOZDYEV MD A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BORYS
Authorized Official - Middle Name:
Authorized Official - Last Name:GVOZDYEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-988-0000
Mailing Address - Street 1:17870 NEWHOPE ST STE 104-197
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5439
Mailing Address - Country:US
Mailing Address - Phone:499-342-8892
Mailing Address - Fax:
Practice Address - Street 1:9940 TALBERT AVE STE 202
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5153
Practice Address - Country:US
Practice Address - Phone:949-988-0000
Practice Address - Fax:949-988-4000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-03
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty