Provider Demographics
NPI:1932887304
Name:BURNOM, AMBRASA N
Entity Type:Individual
Prefix:
First Name:AMBRASA
Middle Name:N
Last Name:BURNOM
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 1:2475 GRAY FALLS DR APT 128
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-6518
Mailing Address - Country:US
Mailing Address - Phone:409-548-2512
Mailing Address - Fax:
Practice Address - Street 1:4825 ALMEDA RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-5655
Practice Address - Country:US
Practice Address - Phone:409-548-2512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes211D00000XPodiatric Medicine & Surgery Service ProvidersAssistant, Podiatric