MEDICARE: ASTRI CAROLINA BURGOS

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	163W00000X	Registered Nurse	898487	TX

General Provider Information

NPI Number	:	1952802381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASTRI CAROLINA BURGOS

Provider Business Mailing Address
First Line	:	5555 SPRING VALLEY RD APT 1059
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-2249
Country	:	US
Telephone Number	:	214-517-6305
Fax Number	:

Provider Business Practice Location Address
First Line	:	5555 SPRING VALLEY RD APT 1059
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-2249
Country	:	US
Telephone Number	:	214-517-6305
Fax Number	:

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

Provider Enumeration Date	:	02/21/2018
Last Update Date	:	02/21/2018

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Directions to “ ASTRI CAROLINA BURGOS ” Practice Location

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