Provider Demographics
NPI:1306694336
Name:BURAK, SVETLANA
Entity type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:BURAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1221
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92022-1221
Mailing Address - Country:US
Mailing Address - Phone:619-800-8504
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1221
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92022-1221
Practice Address - Country:US
Practice Address - Phone:619-800-8504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005471101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional