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NPI Code Detail

MEDICARE: BRANDY LYNN BORUNDA PA

MEDICARE: BRANDY LYNN BORUNDA PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1144881749
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDY LYNN BORUNDA PA
Provider Business Mailing Address
First Line : 11610 VALLE LINDO DR
Second Line :
City : EL PASO
State : TX
Zip : 79927-3420
Country : US
Telephone Number : 915-694-8054
Fax Number :
Provider Business Practice Location Address
First Line : 3600 N GARFIELD ST
Second Line :
City : MIDLAND
State : TX
Zip : 79705-6329
Country : US
Telephone Number : 806-743-3220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2019
Last Update Date : 06/25/2019

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