Basic Information
| Provider Information | |||||||||
| NPI: | 1457080475 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURGOS CHANG | ||||||||
| FirstName: | DALGIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 390 S STATE ROAD 7 | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330236718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547435522 | ||||||||
| FaxNumber: | 9547435632 | ||||||||
| Practice Location | |||||||||
| Address1: | 390 S STATE ROAD 7 | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330236718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547435522 | ||||||||
| FaxNumber: | 9547435632 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2022 | ||||||||
| LastUpdateDate: | 07/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 11019128 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.