Healthcare Provider Details

I. General information

NPI: 1053508861
Provider Name (Legal Business Name): PAUL F BURNETTE CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 KEARNEY ST STE 130
FREMONT CA
94538-2268
US

IV. Provider business mailing address

3155 KEARNEY ST STE 130
FREMONT CA
94538-2268
US

V. Phone/Fax

Practice location:
  • Phone: 510-490-6400
  • Fax: 510-490-6446
Mailing address:
  • Phone: 510-490-6400
  • Fax: 510-490-6446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: