Provider Demographics
NPI:1407668528
Name:BURGOS, VICTORIA JACQUELINE
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:JACQUELINE
Last Name:BURGOS
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 1:2454 N EASTVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-1689
Mailing Address - Country:US
Mailing Address - Phone:602-489-3962
Mailing Address - Fax:
Practice Address - Street 1:44 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-2264
Practice Address - Country:US
Practice Address - Phone:623-772-5195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician