Healthcare Provider Details

I. General information

NPI: 1174359061
Provider Name (Legal Business Name): CRITICAL CARE CONSULTANTS OF BURBANK INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S BUENA VISTA ST
BURBANK CA
91505-4809
US

IV. Provider business mailing address

201 S BUENA VISTA ST STE 440
BURBANK CA
91505-4577
US

V. Phone/Fax

Practice location:
  • Phone: 818-842-4819
  • Fax: 818-842-8551
Mailing address:
  • Phone: 818-842-4819
  • Fax: 818-842-8551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SHERI ROBERTS
Title or Position: MANAGER
Credential:
Phone: 818-606-6861