Healthcare Provider Details

I. General information

NPI: 1902154420
Provider Name (Legal Business Name): HAYDEN M BURKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1848 FREDA LN
CARDIFF BY THE SEA CA
92007-1415
US

IV. Provider business mailing address

1848 FREDA LN
CARDIFF BY THE SEA CA
92007-1415
US

V. Phone/Fax

Practice location:
  • Phone: 760-815-9425
  • Fax:
Mailing address:
  • Phone: 760-815-9425
  • Fax: 619-215-5875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA150361
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: