Provider Demographics
NPI:1942463237
Name:JORGE Y BURGOS MD PC
Entity Type:Organization
Organization Name:JORGE Y BURGOS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:BURGOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-227-0022
Mailing Address - Street 1:750 N EASTERN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-2850
Mailing Address - Country:US
Mailing Address - Phone:702-227-0022
Mailing Address - Fax:702-227-0084
Practice Address - Street 1:750 N EASTERN AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-2850
Practice Address - Country:US
Practice Address - Phone:702-227-0022
Practice Address - Fax:702-227-0084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVAQ146Medicare PIN