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NPI Code Detail

MEDICARE: COYO MELESCIO BURCIAGA

MEDICARE: COYO MELESCIO BURCIAGA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1167G00000XLicensed Psychiatric TechnicianPT 30761CA

General Provider Information

NPI Number : 1053451062
Entity Type Code : Individual
Provider Name (Legal Business Name) : COYO MELESCIO BURCIAGA
Provider Business Mailing Address
First Line : 155 N OCCIDENTAL BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90026-4641
Country : US
Telephone Number : 213-381-2931
Fax Number :
Provider Business Practice Location Address
First Line : 155 N OCCIDENTAL BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90026-4641
Country : US
Telephone Number : 213-381-2931
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2007
Last Update Date : 08/07/2024

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Directions to “ COYO MELESCIO BURCIAGA ” Practice Location

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