MEDICARE: MRS. GABRIELA BURKE-ARMIJO B.S.

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	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1356639462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GABRIELA BURKE-ARMIJO B.S.

Provider Business Mailing Address
First Line	:	1949 VALLEY RIM RD
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92019-1219
Country	:	US
Telephone Number	:	619-906-4621
Fax Number	:	619-234-8884

Provider Business Practice Location Address
First Line	:	1845 LOGAN AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92113-2111
Country	:	US
Telephone Number	:	619-906-4621
Fax Number	:	619-234-8884

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

Provider Enumeration Date	:	07/11/2011
Last Update Date	:	07/11/2011

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