Provider Demographics
NPI:1598534372
Name:BURGOS, ELYZABETH
Entity Type:Individual
Prefix:
First Name:ELYZABETH
Middle Name:
Last Name:BURGOS
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 1:312 COUNTRY ML
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-2443
Mailing Address - Country:US
Mailing Address - Phone:845-891-9174
Mailing Address - Fax:
Practice Address - Street 1:312 COUNTRY ML
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-2443
Practice Address - Country:US
Practice Address - Phone:845-891-9174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program