Healthcare Provider Details

I. General information

NPI: 1629631460
Provider Name (Legal Business Name): JENNIFER MICHELLE BURGANS LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41171 ARRON CT
MURRIETA CA
92562-6004
US

IV. Provider business mailing address

3998 VISTA WAY STE E
OCEANSIDE CA
92056-4514
US

V. Phone/Fax

Practice location:
  • Phone: 951-662-0401
  • Fax:
Mailing address:
  • Phone: 760-295-9830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN256552
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: