Provider Demographics
NPI:1306886684
Name:BURGOS, GLENDA MULET (FNP)
Entity type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:MULET
Last Name:BURGOS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23825 CALLE HOGAR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-3236
Mailing Address - Country:US
Mailing Address - Phone:949-768-5328
Mailing Address - Fax:
Practice Address - Street 1:RITA MEDICAL CLINIC
Practice Address - Street 2:7126 PACIFIC BOULEVARD
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255
Practice Address - Country:US
Practice Address - Phone:323-582-9330
Practice Address - Fax:323-582-8903
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11863363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner