Healthcare Provider Details

I. General information

NPI: 1063169696
Provider Name (Legal Business Name): MRS. EMMA CLAIRE BODA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 S BUENA VISTA ST STE 240
BURBANK CA
91505-4559
US

IV. Provider business mailing address

191 S BUENA VISTA ST STE 240
BURBANK CA
91505-4559
US

V. Phone/Fax

Practice location:
  • Phone: 818-557-7278
  • Fax: 818-557-1603
Mailing address:
  • Phone: 818-557-7278
  • Fax: 818-557-1603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberPA62963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: