Provider Demographics
NPI:1346411543
Name:BURNEY, PHILLIP A (AUD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:A
Last Name:BURNEY
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 N PALM CYN DR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4419
Mailing Address - Country:US
Mailing Address - Phone:760-323-8405
Mailing Address - Fax:760-323-8723
Practice Address - Street 1:1005 N PALM CANYON DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4419
Practice Address - Country:US
Practice Address - Phone:760-323-8405
Practice Address - Fax:760-323-8723
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU248237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0002481Medicaid
CAAU0002481Medicaid
CAZZZ75049ZMedicare PIN