Healthcare Provider Details

I. General information

NPI: 1851418768
Provider Name (Legal Business Name): CYNTHIA DEGUIA BURT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 TENTH ST ESTATE THOMAS
ST THOMAS VI
00802-2102
US

IV. Provider business mailing address

PO BOX 10500
ST THOMAS VI
00801-3500
US

V. Phone/Fax

Practice location:
  • Phone: 340-774-2760
  • Fax: 340-774-2760
Mailing address:
  • Phone: 340-774-2760
  • Fax: 340-774-2760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number48D702841
License Number StateVI

VIII. Authorized Official

Name: CYNTHIA DEGUIA BURT
Title or Position: MEDICAL TECHNOLOGIST
Credential:
Phone: 340-774-2760