Healthcare Provider Details

I. General information

NPI: 1528262284
Provider Name (Legal Business Name): AMBER MICHELLE BURNETTE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 12/03/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N VERMONT AVE ALLERGY CLINIC, 5TH FLOOR
LOS ANGELES CA
90027-5337
US

IV. Provider business mailing address

7907 E ROSE GARDEN LN
SCOTTSDALE AZ
85255-6427
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-4640
  • Fax:
Mailing address:
  • Phone: 202-577-6630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA97788
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA97788
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: