Healthcare Provider Details

I. General information

NPI: 1447339072
Provider Name (Legal Business Name): BRUCE LE'NARD BURRIS M.A., I.M.F.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W MISSION AVE SUITE 103
ESCONDIDO CA
92025-1720
US

IV. Provider business mailing address

125 W MISSION AVE SUITE 103
ESCONDIDO CA
92025-1720
US

V. Phone/Fax

Practice location:
  • Phone: 760-747-3424
  • Fax: 760-747-3435
Mailing address:
  • Phone: 760-747-3424
  • Fax: 760-747-3435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: