Provider Demographics
NPI:1972195642
Name:BORUNDA, ALFONSO
Entity Type:Individual
Prefix:
First Name:ALFONSO
Middle Name:
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 1:801 E CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4607
Mailing Address - Country:US
Mailing Address - Phone:805-332-4568
Mailing Address - Fax:805-332-3487
Practice Address - Street 1:801 E CHAPEL ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4607
Practice Address - Country:US
Practice Address - Phone:805-332-4568
Practice Address - Fax:805-332-3487
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1447244256Medicaid