Provider Demographics
NPI:1437920931
Name:PRESTIGE MEDICAL CLINIC AND URGENT CARE,INC
Entity Type:Organization
Organization Name:PRESTIGE MEDICAL CLINIC AND URGENT CARE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ODURO-BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP-BC
Authorized Official - Phone:909-447-2323
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1801444708Medicaid