Healthcare Provider Details

I. General information

NPI: 1528623758
Provider Name (Legal Business Name): JOSE JULIAN BURGOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9490 NW 41ST ST APT 624
DORAL FL
33178-4972
US

IV. Provider business mailing address

9490 NW 41ST ST APT 624
DORAL FL
33178-4972
US

V. Phone/Fax

Practice location:
  • Phone: 832-244-8494
  • Fax:
Mailing address:
  • Phone: 832-244-8494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberW6592
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberW6592
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME177595
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberW6592
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: