MEDICARE: REID BURNS

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1508126350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REID BURNS

Provider Business Mailing Address
First Line	:	1260 CLEVELAND AVE
Second Line	:	# D210
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-7326
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1260 CLEVELAND AVE
Second Line	:	# D210
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-7326
Country	:	US
Telephone Number	:	619-395-6218
Fax Number	:

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

Provider Enumeration Date	:	05/25/2012
Last Update Date	:	05/25/2012

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Directions to “ REID BURNS ” Practice Location

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