| Borderland Medica, P.a. | |
|
1171 Larry Mahan Dr El Paso TX 79925-6509 | |
| (915) 532-1197 | |
| (915) 532-1198 |
| Full Name | Borderland Medica, P.a. |
|---|---|
| Speciality | Internal Medicine |
| Location | 1171 Larry Mahan Dr, El Paso, Texas |
| Authorized Official Name and Position | Alonso Gandara (MANAGER) |
| Authorized Official Contact | 9155321197 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Borderland Medica, P.a. 1171 Larry Mahan Dr El Paso TX 79925-6509 Ph: (915) 532-1197 | Borderland Medica, P.a. 1171 Larry Mahan Dr El Paso TX 79925-6509 Ph: (915) 532-1197 |
| NPI Number | 1578833109 |
|---|---|
| Provider Enumeration Date | 01/12/2012 |
| Last Update Date | 05/21/2024 |
| Medicare PECOS PAC ID | 4284895764 |
|---|---|
| Medicare Enrollment ID | O20120410000243 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578833109 | NPI | - | NPPES |
| L8460 | Other | TX | TEXAS MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | L8460 (Texas) | Primary |
| Provider Name | Dinorah Nutis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912934928 PECOS PAC ID: 5698836294 Enrollment ID: I20081201000480 |
| Provider Name | Yvette M Luna-bowen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497206643 PECOS PAC ID: 2264712173 Enrollment ID: I20161212002102 |
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