Provider Demographics
NPI:1336312487
Name:BURSTEIN, AMIR (MA,PT)
Entity Type:Individual
Prefix:MR
First Name:AMIR
Middle Name:
Last Name:BURSTEIN
Suffix:
Gender:M
Credentials:MA,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 JUNIPER AVE
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-1768
Mailing Address - Country:US
Mailing Address - Phone:805-225-1077
Mailing Address - Fax:805-225-1077
Practice Address - Street 1:2680 JUNIPER AVE
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-1768
Practice Address - Country:US
Practice Address - Phone:805-225-1077
Practice Address - Fax:805-225-1077
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34312171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor