Provider Demographics
NPI:1720397383
Name:BURGERS, CRYSTAL DANAE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:DANAE
Last Name:BURGERS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 W REDONDO BEACH BLVD
Mailing Address - Street 2:STE. # 500
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4128
Mailing Address - Country:US
Mailing Address - Phone:310-329-3492
Mailing Address - Fax:310-329-3799
Practice Address - Street 1:1045 W REDONDO BEACH BLVD
Practice Address - Street 2:STE. # 500
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4128
Practice Address - Country:US
Practice Address - Phone:310-329-3492
Practice Address - Fax:310-329-3799
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 509268 NP 14759363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology