Provider Demographics
NPI:1346508835
Name:GUSMORINO BORDEN, EDVIGE JANE (CST)
Entity Type:Individual
Prefix:MRS
First Name:EDVIGE
Middle Name:JANE
Last Name:GUSMORINO BORDEN
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 AVANTI CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4917
Mailing Address - Country:US
Mailing Address - Phone:281-413-4978
Mailing Address - Fax:
Practice Address - Street 1:11914 ASTORIA BLVD
Practice Address - Street 2:125
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6064
Practice Address - Country:US
Practice Address - Phone:281-482-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125878246ZS0410X
TXSA00693246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist