MEDICARE: BORDER PEDIATRICS, 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	2080A0000X	Pediatric Adolescent Medicine Physician	K9162	TX

General Provider Information

NPI Number	:	1841347218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BORDER PEDIATRICS, P.A.

Provider Business Mailing Address
First Line	:	4500 N MESA ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-6102
Country	:	US
Telephone Number	:	915-532-9000
Fax Number	:	915-532-9006

Provider Business Practice Location Address
First Line	:	4500 N MESA ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-6102
Country	:	US
Telephone Number	:	915-532-9000
Fax Number	:	915-532-9006

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RUBEN R RONCALLO
Credential	:	M.D.
Telephone Number	:	915-532-9000

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	08/22/2020

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