Provider Demographics
NPI:1881430247
Name:BURGOS, VALENTINA LOURDES
Entity type:Individual
Prefix:
First Name:VALENTINA
Middle Name:LOURDES
Last Name:BURGOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VALENTINA
Other - Middle Name:LOURDES
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MAIDEN NAME
Mailing Address - Street 1:217 50TH ST APT 4R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-1728
Mailing Address - Country:US
Mailing Address - Phone:646-529-2233
Mailing Address - Fax:
Practice Address - Street 1:217 50TH ST APT 4R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-1728
Practice Address - Country:US
Practice Address - Phone:646-529-2233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty