Healthcare Provider Details

I. General information

NPI: 1811164668
Provider Name (Legal Business Name): ANA BURGOS RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 N KROME AVE
HOMESTEAD FL
33030-4460
US

IV. Provider business mailing address

15350 SW 76 TERACE # 202
MIAMI FL
33193
US

V. Phone/Fax

Practice location:
  • Phone: 305-242-8122
  • Fax:
Mailing address:
  • Phone: 305-343-8673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License NumberRT 7080
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: