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General NPI Number Information
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NPI Number | 1659064574
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Entity Type | Individual
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Provider Name | JENNIFER BURGOS
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Gender | Female
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Dates
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Enumeration Date | 05/26/2023
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 2121 W TEMPLE ST
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City | LOS ANGELES
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State | CA
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Zip | 90026-4915
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Country | US
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Telephone | 213-385-5100
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Fax |
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Provider Business Mailing Address
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Address Line | 315 S LA FAYETTE PARK PL APT 215
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City | LOS ANGELES
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State | CA
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Zip | 90057-4624
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Country | US
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Telephone | 323-337-7094
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 128436
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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