Provider Demographics
NPI:1205210531
Name:ODURO-BURTON, EMY (DNP-BC)
Entity Type:Individual
Prefix:DR
First Name:EMY
Middle Name:
Last Name:ODURO-BURTON
Suffix:
Gender:F
Credentials:DNP-BC
Other - Prefix:DR
Other - First Name:EMY
Other - Middle Name:
Other - Last Name:ODURO-JEFFREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP-BC
Mailing Address - Street 1:1984 INDIAN HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3620
Mailing Address - Country:US
Mailing Address - Phone:909-447-2323
Mailing Address - Fax:909-447-1199
Practice Address - Street 1:1984 INDIAN HILL BLVD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3620
Practice Address - Country:US
Practice Address - Phone:909-447-2323
Practice Address - Fax:909-447-1199
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004690363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$Medicaid