Basic Information
| Provider Information | |||||||||
| NPI: | 1477296424 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURCOVSCHI | ||||||||
| FirstName: | LUDMILA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1414 E MAIN ST STE 1414 | ||||||||
| Address2: | |||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934544806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057393924 | ||||||||
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| Practice Location | |||||||||
| Address1: | 901 OAK PARK BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | PISMO BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934493409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054812205 | ||||||||
| FaxNumber: | 8054812206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2022 | ||||||||
| LastUpdateDate: | 06/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP024753 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.