MEDICARE: BORDERLAND MEDICA, P.A.

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
1	207R00000X	Internal Medicine Physician	L8460	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	L8460	OTHER	TX	TEXAS MEDICAL LICENSE

General Provider Information

NPI Number	:	1578833109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BORDERLAND MEDICA, P.A.

Provider Business Mailing Address
First Line	:	1171 LARRY MAHAN DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-6509
Country	:	US
Telephone Number	:	915-532-1197
Fax Number	:	915-532-1198

Provider Business Practice Location Address
First Line	:	1171 LARRY MAHAN DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-6509
Country	:	US
Telephone Number	:	915-532-1197
Fax Number	:	915-532-1198

Authorized Official
Title or Position	:	MANAGER
Name	:	ALONSO GANDARA
Credential	:
Telephone Number	:	915-532-1197

Provider Enumeration Date	:	01/12/2012
Last Update Date	:	05/21/2024

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Directions to “BORDERLAND MEDICA, P.A. ” Practice Location

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