Provider Demographics
NPI:1841530664
Name:BURGOS, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BURGOS
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 1:10300 SW 72ND ST
Mailing Address - Street 2:SUITE 425
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3012
Mailing Address - Country:US
Mailing Address - Phone:786-502-4563
Mailing Address - Fax:305-503-7558
Practice Address - Street 1:10300 SW 72ND ST
Practice Address - Street 2:SUITE 425
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3012
Practice Address - Country:US
Practice Address - Phone:786-502-4563
Practice Address - Fax:305-503-7558
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ 5881235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist