MEDICARE: SVETLANA BURAK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	180005471	IL

General Provider Information

NPI Number	:	1306694336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SVETLANA BURAK

Provider Business Mailing Address
First Line	:	PO BOX 1221
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92022-1221
Country	:	US
Telephone Number	:	619-800-8504
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 1221
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92022-1221
Country	:	US
Telephone Number	:	619-800-8504
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2024
Last Update Date	:	05/06/2024

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Directions to “ SVETLANA BURAK ” Practice Location

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