Provider Demographics
NPI:1306651567
Name:BURGOS, GIOVANNI ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:GIOVANNI
Middle Name:ANTHONY
Last Name:BURGOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5116 RIVER GLEN DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-5254
Mailing Address - Country:US
Mailing Address - Phone:760-705-0959
Mailing Address - Fax:
Practice Address - Street 1:6655 S CIMARRON RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2181
Practice Address - Country:US
Practice Address - Phone:702-853-3578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-10-17
Deactivation Date:2025-05-15
Deactivation Code:
Reactivation Date:2025-06-06
Provider Licenses
StateLicense IDTaxonomies
NYP133499207R00000X
NVLL4472207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine