Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0202X | Pediatric Cardiologist | A142776 | CA |
Y | 2080P0203X | Pediatric Critical Care Doctor | A142776 | CA |
NPI | 1205140704 |
---|---|
Provider Name | Edmund Burke |
First Address | Los Angeles, CA 90010-2814 |
Second Address | San Francisco, CA 94143-2351 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2010 |
Last Update Date | 28/06/2021 |