Provider Demographics
NPI:1710228994
Name:BURSIAN, ENRIQUE R
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:R
Last Name:BURSIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:O34 CALLE CALIFORNIA
Mailing Address - Street 2:URB. PARKVILLE
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3901
Mailing Address - Country:US
Mailing Address - Phone:321-537-4086
Mailing Address - Fax:
Practice Address - Street 1:O34 CALLE CALIFORNIA
Practice Address - Street 2:URB. PARKVILLE
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-3901
Practice Address - Country:US
Practice Address - Phone:321-537-4086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program