Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | BB1369126 | CA |
NPI | 1831220540 |
---|---|
Provider Name | Dr. Andre Burton |
First Address | Anaheim, CA 92804-3729 |
Second Address | Anaheim, CA 92804-3729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BB1369126 | DEA REGISTRATION NUMBER (01) | CA |