Provider Demographics
NPI:1639275969
Name:BURGOS, JORGE Y (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:Y
Last Name:BURGOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JORGE
Other - Middle Name:Y
Other - Last Name:BURGOS CABRERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:750 N EASTERN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-2850
Mailing Address - Country:US
Mailing Address - Phone:702-227-0022
Mailing Address - Fax:702-227-0084
Practice Address - Street 1:750 N EASTERN AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-2850
Practice Address - Country:US
Practice Address - Phone:702-227-0022
Practice Address - Fax:702-227-0084
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10622207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVAQ147ZMedicare PIN