Provider Demographics
NPI:1336954585
Name:BURGOS, JORGE ELIECER JR
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:ELIECER
Last Name:BURGOS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 BURNS AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-2702
Mailing Address - Country:US
Mailing Address - Phone:323-222-1440
Mailing Address - Fax:
Practice Address - Street 1:4445 BURNS AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-2702
Practice Address - Country:US
Practice Address - Phone:323-222-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)