Healthcare Provider Details

I. General information

NPI: 1316649221
Provider Name (Legal Business Name): MS. SARA BURGOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 03/22/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CONDOMINIO SAN VICENTE 8169 CALLE CONCORDIA SUITE 307
PONCE PR
00717
US

IV. Provider business mailing address

CONDOMINIO SAN VICENTE 8169 CALLE CONCORDIA SUITE 307
PONCE PR
00717
US

V. Phone/Fax

Practice location:
  • Phone: 787-284-5884
  • Fax:
Mailing address:
  • Phone: 787-284-5884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: