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General NPI Number Information
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NPI Number | 1760031736
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Entity Type | Individual
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Provider Name | STACEY RENEA BURGOS LM
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Gender | Female
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Dates
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Enumeration Date | 09/11/2019
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 1801 TOWN AND COUNTRY DR UNIT 861
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City | NORCO
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State | CA
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Zip | 92860-8143
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Country | US
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Telephone | 951-268-9008
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Fax | 951-268-9922
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Provider Business Mailing Address
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Address Line | 1801 TOWN AND COUNTRY DR UNIT 861
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City | NORCO
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State | CA
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Zip | 92860-8143
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Country | US
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Telephone | 951-268-9008
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Fax | 951-268-9922
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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 | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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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 | 176B00000X
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Taxonomy Name | Midwife
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License Number | LM620
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License Number State | CA
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