Provider Demographics
NPI:1700777471
Name:BURROUGHS, SYNISHA (LVN)
Entity type:Individual
Prefix:
First Name:SYNISHA
Middle Name:
Last Name:BURROUGHS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12021 WILMINGTON AVENUE
Mailing Address - Street 2:BUILDING 18 (5TH FLOOR - POD B)
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059
Mailing Address - Country:US
Mailing Address - Phone:424-454-5470
Mailing Address - Fax:
Practice Address - Street 1:12021 WILMINGTON AVENUE
Practice Address - Street 2:BUILDING 18 (5TH FLOOR - POD B)
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059
Practice Address - Country:US
Practice Address - Phone:424-454-5470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208021164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse