Provider Demographics
NPI:1245647916
Name:BURGESS, JOHN M (HA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:BURGESS
Suffix:
Gender:M
Credentials:HA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2125 S BROADWAY
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454
Mailing Address - Country:US
Mailing Address - Phone:805-922-2884
Mailing Address - Fax:805-922-2844
Practice Address - Street 1:2125 S BROADWAY
Practice Address - Street 2:SUITE 111
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454
Practice Address - Country:US
Practice Address - Phone:805-922-2884
Practice Address - Fax:805-922-2844
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA3643237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist