Provider Demographics
NPI:1851418768
Name:CYNTHIA DEGUIA BURT
Entity Type:Organization
Organization Name:CYNTHIA DEGUIA BURT
Other - Org Name:DOCTORS CLINICAL LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL TECHNOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:DEGUIA
Authorized Official - Last Name:BURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:340-774-2760
Mailing Address - Street 1:PO BOX 10500
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00801-3500
Mailing Address - Country:US
Mailing Address - Phone:340-774-2760
Mailing Address - Fax:340-774-2760
Practice Address - Street 1:1010 TENTH ST
Practice Address - Street 2:ESTATE THOMAS
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2102
Practice Address - Country:US
Practice Address - Phone:340-774-2760
Practice Address - Fax:340-774-2760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI48D702841291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI1639286180Medicare ID - Type Unspecified