Provider Demographics
NPI:1699560383
Name:BURGESS, ALAN (PSS)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:BURGESS
Suffix:
Gender:
Credentials:PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 1/2 N MANHATTAN PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-1711
Mailing Address - Country:US
Mailing Address - Phone:323-345-3049
Mailing Address - Fax:
Practice Address - Street 1:5318 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-1810
Practice Address - Country:US
Practice Address - Phone:323-293-6291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-12
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist