Provider Demographics
NPI:1871790147
Name:DJORDJEVIC, BORKO B (MD, PHD, FICS)
Entity type:Individual
Prefix:DR
First Name:BORKO
Middle Name:B
Last Name:DJORDJEVIC
Suffix:
Gender:M
Credentials:MD, PHD, FICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2788
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91729-2788
Mailing Address - Country:US
Mailing Address - Phone:909-483-1700
Mailing Address - Fax:909-989-6682
Practice Address - Street 1:8680 MONROE CT
Practice Address - Street 2:SUITES 100 & 200
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4880
Practice Address - Country:US
Practice Address - Phone:909-483-1700
Practice Address - Fax:909-989-6682
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA A31228173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine