Individual
MARIA LOURDES P BURGOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
820 E ORANGE AVE, EUSTIS, FL 32726-4248
(352) 589-1999
(352) 589-5145
Mailing address
820 E ORANGE AVE, EUSTIS, FL 32726-4248
(352) 589-1999
(352) 589-5145
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
ME54370
FL
208000000X
Pediatrics Physician
Primary
ME0054370
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
037046100
—
FL
01
—
09722
BLUE CROSS BLUE SHIELD
FL
01
—
1200629
UNITED HEALTHCARE
FL
01
—
PD066
PEDICARE
FL
Enumeration date
09/07/2006
Last updated
01/27/2012
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