Provider Demographics
NPI:1205611894
Name:BURGOS, CESAR
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:
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 1:11200 W FLAGLER ST STE 214
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1183
Mailing Address - Country:US
Mailing Address - Phone:786-925-5405
Mailing Address - Fax:
Practice Address - Street 1:10132 NW 7TH ST UNIT 204
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4092
Practice Address - Country:US
Practice Address - Phone:786-925-5405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health