Provider Demographics
NPI:1093992562
Name:BURTON, DIANE
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:BURTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 N D ST
Mailing Address - Street 2:2316 VALENCIA AVE.
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-3522
Mailing Address - Country:US
Mailing Address - Phone:909-381-3974
Mailing Address - Fax:909-391-6655
Practice Address - Street 1:1010 N D ST
Practice Address - Street 2:2316 VALENCIA AVE.
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-3522
Practice Address - Country:US
Practice Address - Phone:909-381-3974
Practice Address - Fax:909-391-6655
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral