Healthcare Provider Details

I. General information

NPI: 1508726191
Provider Name (Legal Business Name): STEPHANIE BURTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2025
Last Update Date: 11/19/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 N PARAMOUNT BLVD
LONG BEACH CA
90805-3711
US

IV. Provider business mailing address

6060 N PARAMOUNT BLVD
LONG BEACH CA
90805-3711
US

V. Phone/Fax

Practice location:
  • Phone: 562-630-8672
  • Fax: 562-633-3712
Mailing address:
  • Phone: 562-630-8672
  • Fax: 562-633-3712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number615219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: