Provider Demographics
NPI:1609865427
Name:BURGOS, ARELIS (MD)
Entity Type:Individual
Prefix:
First Name:ARELIS
Middle Name:
Last Name:BURGOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 W PALMETTO PARK RD STE 11O
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3424
Mailing Address - Country:US
Mailing Address - Phone:561-353-3376
Mailing Address - Fax:
Practice Address - Street 1:7000 W PALMETTO PARK RD STE 110
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3429
Practice Address - Country:US
Practice Address - Phone:561-353-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME143043207NP0225X, 207N00000X
CO44721208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO27051064Medicaid
CO27051064Medicaid