Healthcare Provider Details

I. General information

NPI: 1295272318
Provider Name (Legal Business Name): AMY BURCH PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3132 JEFFERSON ST
SAN DIEGO CA
92110-4421
US

IV. Provider business mailing address

2804 GATEWAY OAKS DR STE 100
SACRAMENTO CA
95833-4346
US

V. Phone/Fax

Practice location:
  • Phone: 619-333-8130
  • Fax: 619-333-3906
Mailing address:
  • Phone: 619-333-8130
  • Fax: 619-333-3906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95023149
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95027546
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: