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General NPI Number Information
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NPI Number | 1932887304
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Entity Type | Individual
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Provider Name | AMBRASA N BURNOM
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Gender | Female
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Dates
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Enumeration Date | 07/06/2023
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 4825 ALMEDA RD
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City | HOUSTON
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State | TX
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Zip | 77004-5655
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Country | US
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Telephone | 409-548-2512
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Fax |
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Provider Business Mailing Address
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Address Line | 2475 GRAY FALLS DR APT 128
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City | HOUSTON
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State | TX
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Zip | 77077-6518
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Country | US
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Telephone | 409-548-2512
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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 | 211D00000X
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Taxonomy Name | Podiatric Assistant
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License Number |
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License Number State |
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