Healthcare Provider Details

I. General information

NPI: 1306489042
Provider Name (Legal Business Name): BRIANNA BURGOS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 ALTA ARDEN EXPRESSWAY
SACRAMENTO CA
95825
US

IV. Provider business mailing address

9087 MICAELA CT
SACRAMENTO CA
95829-9297
US

V. Phone/Fax

Practice location:
  • Phone: 916-481-5500
  • Fax:
Mailing address:
  • Phone: 916-541-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number20550
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: