Provider Demographics
NPI:1881245801
Name:BURCIAGA, AARON (LMT)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:BURCIAGA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4170 S DECATUR BLVD STE D9
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-6815
Mailing Address - Country:US
Mailing Address - Phone:702-763-7443
Mailing Address - Fax:
Practice Address - Street 1:4170 S DECATUR BLVD STE D9
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-6815
Practice Address - Country:US
Practice Address - Phone:702-763-7443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator