Healthcare Provider Details

I. General information

NPI: 1760300610
Provider Name (Legal Business Name): BUNDUKAMARA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 SINTON RD STE 104
COLORADO SPRINGS CO
80907-5085
US

IV. Provider business mailing address

3720 SINTON RD STE 104
COLORADO SPRINGS CO
80907-5085
US

V. Phone/Fax

Practice location:
  • Phone: 719-493-9555
  • Fax: 719-284-4627
Mailing address:
  • Phone: 719-493-9555
  • Fax: 719-284-4627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: THOMAS BARNES
Title or Position: ADMINISTRATOR
Credential:
Phone: 973-943-0967