MEDICARE: ZAMYRIA FRUCTOSE BURGESS

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	106S00000X	Behavior Technician		CA

General Provider Information

NPI Number	:	1356294896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZAMYRIA FRUCTOSE BURGESS

Provider Business Mailing Address
First Line	:	1075 CREEKSIDE RIDGE DR STE 280
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-3504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2497 GOLDEN GATE AVE RM 325
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-4315
Country	:	US
Telephone Number	:	704-206-0328
Fax Number	:

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

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	02/16/2026

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Directions to “ ZAMYRIA FRUCTOSE BURGESS ” Practice Location

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