Provider Demographics
NPI:1760450225
Name:BURBANK, RONALD BRENT JR (DO)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:BRENT
Last Name:BURBANK
Suffix:JR
Gender:M
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:PO BOX 555191
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2944
Mailing Address - Country:US
Mailing Address - Phone:760-725-9804
Mailing Address - Fax:760-725-1544
Practice Address - Street 1:14021 BOQUITA DR
Practice Address - Street 2:ATTN: MENTAL HEALTH
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5191
Practice Address - Country:US
Practice Address - Phone:760-725-9804
Practice Address - Fax:760-725-1544
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS05-266932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry