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General NPI Number Information
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NPI Number | 1710604525
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Entity Type | Individual
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Provider Name | VICMAR BURGONIO FNP
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Gender | Male
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Dates
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Enumeration Date | 10/24/2022
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Last Update Date | 06/08/2025
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Provider Practice Location Address
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Address Line | 17100 PIONEER BLVD STE 420
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City | ARTESIA
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State | CA
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Zip | 90701-2773
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Country | US
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Telephone | 562-246-8103
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Fax |
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Provider Business Mailing Address
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Address Line | 4330 E MIRALOMA AVE
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City | ANAHEIM
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State | CA
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Zip | 92807-1886
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Country | US
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Telephone |
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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 | NP95022430
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License Number State | CA
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