Provider Demographics
NPI:1093808933
Name:BURSTEIN MD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:BURSTEIN MD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-222-2443
Mailing Address - Street 1:24013 VENTURA BLVD # 101
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1094
Mailing Address - Country:US
Mailing Address - Phone:818-222-2443
Mailing Address - Fax:818-222-2491
Practice Address - Street 1:24013 VENTURA BLVD # 101
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1094
Practice Address - Country:US
Practice Address - Phone:818-222-2443
Practice Address - Fax:818-222-2491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53328207R00000X
CAA53604208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A536040Medicaid
CAW18552Medicare ID - Type Unspecified