Healthcare Provider Details

I. General information

NPI: 1831563717
Provider Name (Legal Business Name): CHRISTIAN Z BURKHARD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2015
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 RAMONA BLVD STE H
IRWINDALE CA
91706-3752
US

IV. Provider business mailing address

1205 CYPRESS ST SPC 114
SAN DIMAS CA
91773-3520
US

V. Phone/Fax

Practice location:
  • Phone: 626-337-3828
  • Fax:
Mailing address:
  • Phone: 626-461-4887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: