Provider Demographics
NPI:1518677152
Name:BURMISTROVA, IRINA
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:BURMISTROVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 OAKCREST DR UNIT 406
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-2152
Mailing Address - Country:US
Mailing Address - Phone:917-200-3240
Mailing Address - Fax:
Practice Address - Street 1:4041 OAKCREST DR UNIT 406
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-2152
Practice Address - Country:US
Practice Address - Phone:917-200-3240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant