Provider Demographics
NPI:1437248572
Name:BURNS, MICHELE IRENE (PA)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:IRENE
Last Name:BURNS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 W. SUNFLOWER AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704
Mailing Address - Country:US
Mailing Address - Phone:714-619-8777
Mailing Address - Fax:714-619-8770
Practice Address - Street 1:3401 W. SUNFLOWER AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704
Practice Address - Country:US
Practice Address - Phone:714-619-8777
Practice Address - Fax:714-619-8770
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PA160230Medicaid
CA00PA160230Medicaid