Healthcare Provider Details

I. General information

NPI: 1881198166
Provider Name (Legal Business Name): MELISSA MARIE BURMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10505 SORRENTO VALLEY RD
SAN DIEGO CA
92121-1618
US

IV. Provider business mailing address

924 TIDE CT
CARLSBAD CA
92011-1145
US

V. Phone/Fax

Practice location:
  • Phone: 858-793-7860
  • Fax: 619-814-5414
Mailing address:
  • Phone: 650-564-2363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberA174167
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: