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General NPI Number Information
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NPI Number | 1649057514
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Entity Type | Individual
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Provider Name | CASSIDY BURON PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/13/2023
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 2400 UNSER BLVD SE
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City | RIO RANCHO
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State | NM
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Zip | 87124-3392
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Country | US
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Telephone | 505-253-7878
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Fax |
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Provider Business Mailing Address
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Address Line | 6555 BASKET WEAVER AVE NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-6108
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Country | US
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Telephone | 808-683-2371
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2023-0261
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License Number State | NM
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