Provider Demographics
NPI:1134315500
Name:ALICIA BORDON MD, PA
Entity Type:Organization
Organization Name:ALICIA BORDON MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:RAQUEL
Authorized Official - Last Name:BORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-880-5266
Mailing Address - Street 1:746 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-1635
Mailing Address - Country:US
Mailing Address - Phone:713-880-5266
Mailing Address - Fax:713-880-8515
Practice Address - Street 1:720 W 11TH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-6714
Practice Address - Country:US
Practice Address - Phone:713-802-2565
Practice Address - Fax:713-880-8515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLL2149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty