Individual
MRS. GENY BRABANTE BURGOS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
123 S COMMERCE ST, STE E, STOCKTON, CA 95202
(209) 939-9512
(209) 939-1226
Mailing address
5858 CARIBBEAN CIRCLE, STOCKTON, CA 95210
(209) 474-7752
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A53610
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A536100
—
CA
Enumeration date
01/28/2006
Last updated
07/08/2007
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