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1306651567 NPI number — GIOVANNI ANTHONY BURGOS MD

NPI Number: 1306651567
Health Care Provider/Practitioner: GIOVANNI ANTHONY BURGOS MD

Information about “1306651567” NPI (GIOVANNI ANTHONY BURGOS MD) exists in 1306651567 in HTML format HTML  |  1306651567 in plain Text format TXT  |  1306651567 in PDF (Portable Document Format) PDF  |  1306651567 in an XML format XML  formats.

NPI Number : 1306651567 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1306651567",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BURGOS",
    "FirstName": "GIOVANNI",
    "MiddleName": "ANTHONY",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5116 RIVER GLEN DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAS VEGAS",
    "MailingAddressStateName": "NV",
    "MailingAddressPostalCode": "89103-5254",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "760-705-0959",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6655 S CIMARRON RD STE 100",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAS VEGAS",
    "PracticeLocationAddressStateName": "NV",
    "PracticeLocationAddressPostalCode": "89113-2181",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "702-853-3578",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/12/2025",
    "LastUpdateDate": "10/17/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "05/15/2025",
    "NPIReactivationDate": "06/06/2025",
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": "P133499",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": "LL4472",
          "LicenseNumberStateCode": "NV",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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