Provider Demographics
NPI:1912495136
Name:BURTON, MELISSA ROBYN
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ROBYN
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 1:1955 CARMEN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-4012
Mailing Address - Country:US
Mailing Address - Phone:917-674-9606
Mailing Address - Fax:
Practice Address - Street 1:1955 CARMEN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-4012
Practice Address - Country:US
Practice Address - Phone:917-674-9606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered