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General NPI Number Information
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NPI Number | 1306651567
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Entity Type | Individual
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Provider Name | GIOVANNI ANTHONY BURGOS MD
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Gender | Male
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 6655 S CIMARRON RD STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89113-2181
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Country | US
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Telephone | 702-853-3578
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Fax |
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Provider Business Mailing Address
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Address Line | 5116 RIVER GLEN DR
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City | LAS VEGAS
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State | NV
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Zip | 89103-5254
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Country | US
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Telephone | 760-705-0959
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | P133499
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | LL4472
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License Number State | NV
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