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General NPI Number Information
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NPI Number | 1013455351
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Entity Type | Individual
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Provider Name | DENISSE BURGOS-JIMENEZ
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Gender | Female
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Dates
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Enumeration Date | 02/07/2017
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Last Update Date | 11/11/2021
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Provider Practice Location Address
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Address Line | 56 FRANKLIN ST
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City | WATERBURY
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State | CT
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Zip | 06706
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Country | US
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Telephone | 860-989-6067
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Fax |
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Provider Business Mailing Address
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Address Line | 841 NEW BRITAIN AVE
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City | HARTFORD
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State | CT
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Zip | 06106-3920
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3767
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 3767
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License Number State | CT
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