Provider Demographics
NPI:1972856714
Name:TAMIKA M. BURRUS, M.D. - PC
Entity Type:Organization
Organization Name:TAMIKA M. BURRUS, M.D. - PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMIKA
Authorized Official - Middle Name:MARQUITTA
Authorized Official - Last Name:BURRUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-913-4350
Mailing Address - Street 1:1300 N VERMONT AVE
Mailing Address - Street 2:1ST FLOOR - DOCTOR'S TOWER
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6005
Mailing Address - Country:US
Mailing Address - Phone:323-913-4350
Mailing Address - Fax:323-913-4351
Practice Address - Street 1:1300 N VERMONT AVE
Practice Address - Street 2:1ST FLOOR - DOCTOR'S TOWER
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6005
Practice Address - Country:US
Practice Address - Phone:323-913-4350
Practice Address - Fax:323-913-4351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular NeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFR145ZMedicare PIN