Provider Demographics
NPI:1568754869
Name:BURCHETTE, CHARLES PARK
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:PARK
Last Name:BURCHETTE
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 1:5820 YOLANDA AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1450
Mailing Address - Country:US
Mailing Address - Phone:818-404-8336
Mailing Address - Fax:
Practice Address - Street 1:5820 YOLANDA AVE APT 8
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1450
Practice Address - Country:US
Practice Address - Phone:818-404-8336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA716149163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool