Provider Demographics
NPI:1255528576
Name:BURCIAGA, MARCELO ANTONIO (DO)
Entity type:Individual
Prefix:DR
First Name:MARCELO
Middle Name:ANTONIO
Last Name:BURCIAGA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7055 LINDA LN
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-1228
Mailing Address - Country:US
Mailing Address - Phone:626-214-6269
Mailing Address - Fax:909-446-7277
Practice Address - Street 1:7055 LINDA LN
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-1228
Practice Address - Country:US
Practice Address - Phone:626-214-6269
Practice Address - Fax:909-446-7277
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A9555207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine