Provider Demographics
NPI:1194315663
Name:BURGOS, RITA (CAS)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:BURGOS
Suffix:
Gender:F
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 FAIR PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-2125
Mailing Address - Country:US
Mailing Address - Phone:323-395-4391
Mailing Address - Fax:
Practice Address - Street 1:454 N AVENUE 56 # 1
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-3335
Practice Address - Country:US
Practice Address - Phone:323-395-4391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No132700000XDietary & Nutritional Service ProvidersDietary Manager
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No175F00000XOther Service ProvidersNaturopath