Provider Demographics
NPI:1578833109
Name:BORDERLAND MEDICA, P.A.
Entity type:Organization
Organization Name:BORDERLAND MEDICA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALONSO
Authorized Official - Middle Name:
Authorized Official - Last Name:GANDARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-532-1197
Mailing Address - Street 1:1171 LARRY MAHAN DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-6509
Mailing Address - Country:US
Mailing Address - Phone:915-532-1197
Mailing Address - Fax:915-532-1198
Practice Address - Street 1:1171 LARRY MAHAN DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-6509
Practice Address - Country:US
Practice Address - Phone:915-532-1197
Practice Address - Fax:915-532-1198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8460207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL8460OtherTEXAS MEDICAL LICENSE