Healthcare Provider Details

I. General information

NPI: 1881520799
Provider Name (Legal Business Name): AARON BORUNDA ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 LA CANA DR
HACIENDA HEIGHTS CA
91745-4226
US

IV. Provider business mailing address

1924 LA CANA DR
HACIENDA HEIGHTS CA
91745-4226
US

V. Phone/Fax

Practice location:
  • Phone: 626-506-7804
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000054717
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: