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NPI Code Detail

MEDICARE: TINA MARIE BURROW

MEDICARE:   TINA MARIE BURROW
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
1171M00000XCase Manager/Care Coordinator4729CA

General Provider Information

NPI Number : 1417176090
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA MARIE BURROW
Provider Business Mailing Address
First Line : 7012 JAMIESON AVE
Second Line :
City : RESEDA
State : CA
Zip : 91335-4816
Country : US
Telephone Number : 818-609-7519
Fax Number :
Provider Business Practice Location Address
First Line : 8745 PARTHENIA PL STE 4
Second Line :
City : NORTH HILLS
State : CA
Zip : 91343-5157
Country : US
Telephone Number : 818-895-5002
Fax Number : 818-895-5502
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2007
Last Update Date : 07/08/2007

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Directions to “ TINA MARIE BURROW ” Practice Location

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