Provider Demographics
NPI:1619091055
Name:BURNETT, EARLA MAHALIA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:EARLA
Middle Name:MAHALIA
Last Name:BURNETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4419 E LAVANTE ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-2748
Mailing Address - Country:US
Mailing Address - Phone:562-230-1253
Mailing Address - Fax:
Practice Address - Street 1:1250 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3026
Practice Address - Country:US
Practice Address - Phone:562-437-0831
Practice Address - Fax:562-624-2725
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 16707363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical