Provider Demographics
NPI:1407546641
Name:BURCHFIELD, KEATON
Entity Type:Individual
Prefix:
First Name:KEATON
Middle Name:
Last Name:BURCHFIELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 MANHATTAN DR
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-8011
Mailing Address - Country:US
Mailing Address - Phone:813-777-6816
Mailing Address - Fax:
Practice Address - Street 1:729 MANHATTAN DR
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-8011
Practice Address - Country:US
Practice Address - Phone:813-777-6816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program