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General NPI Number Information
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NPI Number | 1679012041
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Entity Type | Individual
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Provider Name | MICHAEL LEE BURRIS FNP
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Gender | Male
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Dates
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Enumeration Date | 02/18/2017
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Last Update Date | 03/29/2021
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Provider Practice Location Address
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Address Line | 26991 CROWN VALLEY PKWY STE 100
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6528
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Country | US
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Telephone | 949-582-5430
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Fax | 949-348-9513
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Provider Business Mailing Address
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Address Line | 11 MAREBLU STE 210
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City | ALISO VIEJO
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State | CA
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Zip | 92656-3044
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Country | US
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Telephone | 949-831-1001
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95006035
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License Number State | CA
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