Provider Demographics
NPI:1396493458
Name:BURDA, HALEY
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:BURDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 E 9TH ST UNIT 8
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-2931
Mailing Address - Country:US
Mailing Address - Phone:951-966-7490
Mailing Address - Fax:
Practice Address - Street 1:1412 E 9TH ST UNIT 8
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-2931
Practice Address - Country:US
Practice Address - Phone:951-966-7490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACPR495A77897OtherANTHEM BLUE CROSS