Healthcare Provider Details

I. General information

NPI: 1356972194
Provider Name (Legal Business Name): PRESTIGE MEDICAL CLINIC AND URGENT CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1984 INDIAN HILL BLVD
POMONA CA
91767-3620
US

IV. Provider business mailing address

1984 INDIAN HILL BLVD
POMONA CA
91767-3620
US

V. Phone/Fax

Practice location:
  • Phone: 909-447-2323
  • Fax: 909-447-1199
Mailing address:
  • Phone: 909-447-2323
  • Fax: 909-447-1199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EMY ODURO-BURTON
Title or Position: PRESIDENT
Credential: DNP-BC
Phone: 909-447-2323