Healthcare Provider Details

I. General information

NPI: 1164609558
Provider Name (Legal Business Name): ELIZABETH B. BURGAMY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3257 CAMINO DE LOS COCHES, SUITE 301
CARLSBAD CA
92009-8774
US

IV. Provider business mailing address

3860 CALLE FORTUNADA SUITE 200
SAN DIEGO CA
92123-4802
US

V. Phone/Fax

Practice location:
  • Phone: 760-633-3640
  • Fax: 760-633-3644
Mailing address:
  • Phone: 858-636-4300
  • Fax: 858-636-4319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA99859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: