Healthcare Provider Details

I. General information

NPI: 1841822467
Provider Name (Legal Business Name): REGINA B BURTON LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16424 CALLE CASTOR CIR
HUNTINGTON BEACH CA
92649-5217
US

IV. Provider business mailing address

2644 30TH ST STE 100
SANTA MONICA CA
90405-3051
US

V. Phone/Fax

Practice location:
  • Phone: 657-274-8364
  • Fax:
Mailing address:
  • Phone: 310-450-2024
  • Fax: 310-450-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number682929
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: