Healthcare Provider Details

I. General information

NPI: 1528798600
Provider Name (Legal Business Name): KIRA ANA GBUR BC-HAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 SANTA BARBARA BLVD STE 102
CAPE CORAL FL
33991-4333
US

IV. Provider business mailing address

608 SE 13TH PL APT B
CAPE CORAL FL
33990-2672
US

V. Phone/Fax

Practice location:
  • Phone: 239-673-9507
  • Fax:
Mailing address:
  • Phone: 310-448-3188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number5649
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: