Basic Information
Provider Information
NPI: 1003017906
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BURZELL
FirstName: LINDEN
MiddleName: JOHN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3142 VISTA WAY
Address2: SUITE 100
City: OCEANSIDE
State: CA
PostalCode: 920563627
CountryCode: US
TelephoneNumber: 8662282236
FaxNumber: 7607389047
Practice Location
Address1: 3142 VISTA WAY
Address2: SUITE 100
City: OCEANSIDE
State: CA
PostalCode: 920563627
CountryCode: US
TelephoneNumber: 8662282236
FaxNumber: 7607389047
Other Information
ProviderEnumerationDate: 05/29/2007
LastUpdateDate: 11/03/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/03/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XA112617CAY Allopathic & Osteopathic PhysiciansFamily Medicine 
207Q00000XTRN # 11434FLN Allopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
A11261701CAMEDICAL LICENSEOTHER
FB216801801CADEAOTHER


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