Healthcare Provider Details

I. General information

NPI: 1821058355
Provider Name (Legal Business Name): KATHRYN H. BURNHAM PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N ROSE AVE STE 320
OXNARD CA
93030-7648
US

IV. Provider business mailing address

1700 N ROSE AVE STE 320
OXNARD CA
93030-7648
US

V. Phone/Fax

Practice location:
  • Phone: 805-485-8709
  • Fax: 805-485-3561
Mailing address:
  • Phone: 805-485-8709
  • Fax: 805-485-3561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number004734
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: