Provider Demographics
NPI:1184358400
Name:BURGOS, JAMES PATRICK
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:PATRICK
Last Name:BURGOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 PERALTA BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-5755
Mailing Address - Country:US
Mailing Address - Phone:510-713-3202
Mailing Address - Fax:510-713-0684
Practice Address - Street 1:37437 GLENMOOR DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-5731
Practice Address - Country:US
Practice Address - Phone:510-713-3200
Practice Address - Fax:510-713-0684
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1426770421101YA0400X
CACI45211124101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)