Provider Demographics
NPI:1134250970
Name:CORPUS CHRISTI TOTS & TEENS, PA
Entity type:Organization
Organization Name:CORPUS CHRISTI TOTS & TEENS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BORCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-991-1885
Mailing Address - Street 1:6434 SARATOGA BLVD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3425
Mailing Address - Country:US
Mailing Address - Phone:361-991-1885
Mailing Address - Fax:361-991-1839
Practice Address - Street 1:6434 SARATOGA BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3425
Practice Address - Country:US
Practice Address - Phone:361-991-1885
Practice Address - Fax:361-991-1839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX605088363LF0000X
TX533345363LP0200X
TXK5826208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty