Provider Demographics
NPI:1073737987
Name:BURNS, BENFORD TYRONE (RPT)
Entity type:Individual
Prefix:MR
First Name:BENFORD
Middle Name:TYRONE
Last Name:BURNS
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3513 BARRY AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-2801
Mailing Address - Country:US
Mailing Address - Phone:310-390-4783
Mailing Address - Fax:310-398-8275
Practice Address - Street 1:3513 BARRY AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-2801
Practice Address - Country:US
Practice Address - Phone:310-390-4783
Practice Address - Fax:310-398-8275
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6370171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist