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General NPI Number Information
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NPI Number | 1548646334
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Entity Type | Organization
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Legal Business Name | MARIA LOURDES P BURGOS , MD
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Dates
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Enumeration Date | 08/04/2015
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Last Update Date | 08/04/2015
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Provider Practice Location Address
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Address Line | 820 E ORANGE AVE
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City | EUSTIS
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State | FL
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Zip | 32726-4248
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Country | US
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Telephone | 352-589-1999
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Fax | 352-589-5145
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Provider Business Mailing Address
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Address Line | 820 E ORANGE AVE
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City | EUSTIS
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State | FL
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Zip | 32726-4248
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Country | US
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Telephone | 352-589-1999
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Fax | 352-589-5145
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MARIA LOURDES P BURGOS
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Credential | MD
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Telephone | 352-255-3688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME 054370
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License Number State | FL
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