Healthcare Provider Details

I. General information

NPI: 1912453077
Provider Name (Legal Business Name): CLAUDIA L BURGOS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 08/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4363 COMPTON AVE
LOS ANGELES CA
90011-3811
US

IV. Provider business mailing address

4363 S COMPTON AVE
LOS ANGELES CA
90011
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-1122
  • Fax:
Mailing address:
  • Phone: 310-423-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number60788
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: