Provider Demographics
NPI:1598072449
Name:BURLEY, BRIAN PATRICK
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:PATRICK
Last Name:BURLEY
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 1:11512 B AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-2605
Mailing Address - Country:US
Mailing Address - Phone:530-889-7285
Mailing Address - Fax:
Practice Address - Street 1:1115 S BLUFF DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-1148
Practice Address - Country:US
Practice Address - Phone:916-532-9497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program