Healthcare Provider Details

I. General information

NPI: 1699917138
Provider Name (Legal Business Name): DAMIEN JOHANN BURGESS D.C., APRN, NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20072 SW BIRCH ST STE 100
NEWPORT BEACH CA
92660-0794
US

IV. Provider business mailing address

20072 SW BIRCH ST STE 100
NEWPORT BEACH CA
92660-0794
US

V. Phone/Fax

Practice location:
  • Phone: 949-757-1150
  • Fax:
Mailing address:
  • Phone: 949-757-1150
  • Fax: 949-757-1170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number31139
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number826830
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95014074
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: