Provider Demographics
NPI:1609358399
Name:BORUNDA, CRISTOPHER LYNN
Entity Type:Individual
Prefix:
First Name:CRISTOPHER
Middle Name:LYNN
Last Name:BORUNDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1567 DRURY DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75232-1939
Mailing Address - Country:US
Mailing Address - Phone:469-744-4897
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:4200 LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6733
Practice Address - Country:US
Practice Address - Phone:214-515-6130
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209533224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant