Provider Demographics
NPI:1962617944
Name:BURKE, JONATHAN F (LAC, QME)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:F
Last Name:BURKE
Suffix:
Gender:M
Credentials:LAC, QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2835 CAMINO DEL RIO SOUTH
Mailing Address - Street 2:SUITE 120A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108
Mailing Address - Country:US
Mailing Address - Phone:619-574-0845
Mailing Address - Fax:619-574-0840
Practice Address - Street 1:2835 CAMINO DEL RIO SOUTH
Practice Address - Street 2:SUITE 120A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:619-574-0845
Practice Address - Fax:619-574-0840
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC5481171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist