Healthcare Provider Details

I. General information

NPI: 1245849272
Provider Name (Legal Business Name): TROY BURG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4154 MOUNTCASTLE WAY
SAN JOSE CA
95136-1754
US

IV. Provider business mailing address

4154 MOUNTCASTLE WAY
SAN JOSE CA
95136-1754
US

V. Phone/Fax

Practice location:
  • Phone: 408-891-0349
  • Fax:
Mailing address:
  • Phone: 408-891-0349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-79186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: