MEDICARE: NANCY I SALINAS BURGETT BCBA

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	1-11-8008	AZ

General Provider Information

NPI Number	:	1598174617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY I SALINAS BURGETT BCBA

Provider Business Mailing Address
First Line	:	3008 E SIERRA ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-1930
Country	:	US
Telephone Number	:	956-483-5036
Fax Number	:

Provider Business Practice Location Address
First Line	:	21505 N 78TH AVE STE 125
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-3356
Country	:	US
Telephone Number	:	956-483-5036
Fax Number	:	480-812-4831

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

Provider Enumeration Date	:	08/04/2014
Last Update Date	:	04/04/2017

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