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1376034348 NPI number — MR. EDDIE REGINALD BURSTON II

NPI Number: 1376034348
Health Care Provider/Practitioner: MR. EDDIE REGINALD BURSTON II

Information about “1376034348” NPI (MR. EDDIE REGINALD BURSTON II) exists in 1376034348 in HTML format HTML  |  1376034348 in plain Text format TXT  |  1376034348 in PDF (Portable Document Format) PDF  |  1376034348 in an XML format XML  formats.

NPI Number : 1376034348 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1376034348",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BURSTON",
    "FirstName": "EDDIE",
    "MiddleName": "REGINALD",
    "NamePrefix": "MR.",
    "NameSuffix": "II",
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "19612 VILLA CT EHS7",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SOUTHFIELD",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48076",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "858-265-9992",
    "MailingAddressFaxNumber": "858-798-5221",
    "FirstLinePracticeLocationAddress": "12727 CAMINO EMPARRADO",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAN DIEGO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92128",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "858-265-9992",
    "PracticeLocationAddressFaxNumber": "858-798-5221",
    "EnumerationDate": "05/24/2018",
    "LastUpdateDate": "05/24/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "253Z00000X",
          "TaxonomyName": "In Home Supportive Care Agency",
          "LicenseNumber": "B8163X",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "253Z00000X",
          "TaxonomyName": "In Home Supportive Care Agency",
          "LicenseNumber": "7516084757",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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