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General NPI Number Information
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NPI Number | 1871852236
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Entity Type | Individual
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Provider Name | FRED HURD BURBANK M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/04/2012
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Last Update Date | 05/04/2012
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Provider Practice Location Address
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Address Line | 24040 CAMINO DEL AVION A326
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City | DANA POINT
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State | CA
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Zip | 92629-4005
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Country | US
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Telephone | 949-496-0026
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Fax | 949-496-3247
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Provider Business Mailing Address
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Address Line | 24040 CAMINO DEL AVION A326
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City | DANA POINT
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State | CA
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Zip | 92629-4005
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Country | US
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Telephone | 949-496-0026
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Fax | 949-496-3247
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G16735
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | G16735
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License Number State | CA
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