Healthcare Provider Details

I. General information

NPI: 1447901277
Provider Name (Legal Business Name): BROOKLYN BLANCHE BURAS DNP, FNP - BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 01/13/2022
Certification Date: 12/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 SAINT CHARLES DR
THOUSAND OAKS CA
91360-3953
US

IV. Provider business mailing address

169 N EDGEMONT ST APT 3
LOS ANGELES CA
90004-6249
US

V. Phone/Fax

Practice location:
  • Phone: 805-449-8781
  • Fax: 805-449-4224
Mailing address:
  • Phone: 504-287-6387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95019697
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: