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MARIA LOURDES P BURGOS
>> Pediatrics >> Allopathic & Osteopathic PhysiciansRegistrant NPI Number: 1972607349
Individual Registrant: MARIA LOURDES P BURGOS
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
820 E ORANGE AVE EUSTIS, FL 32726-4248 US
Tel: 352-589-1999 Fax: 352-589-5145
Tel: 352-589-1999 Fax: 352-589-5145
Contact information for business:
820 E ORANGE AVE EUSTIS, FL 32726-4248 US
Tel: 352-589-1999 Fax: 352-589-5145
Tel: 352-589-1999 Fax: 352-589-5145
Registration Information:
NPI: 1972607349
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 208000000X | Allopathic & Osteopathic Physicians Pediatrics | FL | ME0054370 |
| N | 207Q00000X | Allopathic & Osteopathic Physicians Family Medicine | FL | ME54370 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 037046100 | FL | 05 | |
| PEDICARE | PD066 | FL | 01 |
| UNITED HEALTHCARE | 1200629 | FL | 01 |
| BLUE CROSS BLUE SHIELD | 09722 | FL | 01 |
