Provider Demographics
NPI:1710428529
Name:BURSE BRIGGS, IVA
Entity Type:Individual
Prefix:
First Name:IVA
Middle Name:
Last Name:BURSE BRIGGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2359 DRIFTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROSAMOND
Mailing Address - State:CA
Mailing Address - Zip Code:93560-6759
Mailing Address - Country:US
Mailing Address - Phone:661-802-6286
Mailing Address - Fax:
Practice Address - Street 1:506 W JACKMAN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2531
Practice Address - Country:US
Practice Address - Phone:661-802-6286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program