Healthcare Provider Details

I. General information

NPI: 1467976340
Provider Name (Legal Business Name): CHERYL ADELE BURIAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHERYL ADELE BURIAN-BALDWIN M.D.

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 08/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6572 CASCADE ST
SAN DIEGO CA
92122-2425
US

IV. Provider business mailing address

6572 CASCADE ST
SAN DIEGO CA
92122-2425
US

V. Phone/Fax

Practice location:
  • Phone: 858-455-7346
  • Fax:
Mailing address:
  • Phone: 858-455-7346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG28525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: