Healthcare Provider Details

I. General information

NPI: 1992836290
Provider Name (Legal Business Name): KRISTA LYNN BURRIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTA BURRIS KIM MD

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72780 COUNTRY CLUB DR SUITE 203
RANCHO MIRAGE CA
92270-4150
US

IV. Provider business mailing address

72780 COUNTRY CLUB DR SUITE 203
RANCHO MIRAGE CA
92270-4150
US

V. Phone/Fax

Practice location:
  • Phone: 760-674-3847
  • Fax: 760-674-3845
Mailing address:
  • Phone: 760-674-3847
  • Fax: 760-674-3845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA068708
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA068708
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: