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NPI Code Detail

MEDICARE: MISS STELLA JEANNE BURCIAGA PT

MEDICARE:  MISS STELLA JEANNE BURCIAGA  PT
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
1225100000XPhysical Therapist3283NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457481749
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS STELLA JEANNE BURCIAGA PT
Provider Business Mailing Address
First Line : 154 ROADRUNNER
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701
Country : US
Telephone Number : 505-718-8309
Fax Number :
Provider Business Practice Location Address
First Line : 601 E LINCOLN ST
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-4502
Country : US
Telephone Number : 505-425-2998
Fax Number : 505-425-2897
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2007
Last Update Date : 12/27/2018

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Directions to “ MISS STELLA JEANNE BURCIAGA PT” Practice Location

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