Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A112617 | CA |
N | 207Q00000X | Family Doctor | TRN # 11434 | FL |
NPI | 1003017906 |
---|---|
Provider Name | Dr. Linden John Burzell |
First Address | Oceanside, CA 92056-3627 |
Second Address | Oceanside, CA 92056-3627 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 03/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A112617 | MEDICAL LICENSE (01) | CA |
FB2168018 | DEA (01) | CA |