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General NPI Number Information
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NPI Number | 1194878322
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Entity Type | Individual
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Provider Name | COLLEEN MICHELE BURKE DOM, L.AC.
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Gender | Female
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 11/24/2008
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Provider Practice Location Address
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Address Line | 215 30TH AVE
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City | SANTA CRUZ
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State | CA
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Zip | 95062-5440
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Country | US
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Telephone | 505-501-5228
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Fax |
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Provider Business Mailing Address
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Address Line | 215 30TH AVE
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City | SANTA CRUZ
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State | CA
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Zip | 95062-5440
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Country | US
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Telephone | 505-501-5228
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 739
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 6653
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License Number State | CA
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