Healthcare Provider Details

I. General information

NPI: 1902873763
Provider Name (Legal Business Name): CINDY BURGHARDT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N FRIO ST
SAN ANTONIO TX
78207-3034
US

IV. Provider business mailing address

16620 N US HIGHWAY 281 SUITE 300
SAN ANTONIO TX
78232-2327
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-1231
  • Fax: 210-616-0704
Mailing address:
  • Phone: 210-614-1231
  • Fax: 210-616-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA02997
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: