Healthcare Provider Details

I. General information

NPI: 1730112715
Provider Name (Legal Business Name): ALBERTO BURGOS-TIBURCIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 W 68TH ST STE 122
HIALEAH FL
33016-5502
US

IV. Provider business mailing address

2360 W 68TH ST STE 122
HIALEAH FL
33016-5502
US

V. Phone/Fax

Practice location:
  • Phone: 305-200-5705
  • Fax: 305-392-1217
Mailing address:
  • Phone: 305-200-5705
  • Fax: 305-392-1217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME 104754
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME104754
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number227704
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberME 104754
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: