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General NPI Number Information
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NPI Number | 1356972194
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Entity Type | Organization
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Legal Business Name | PRESTIGE MEDICAL CLINIC AND URGENT CARE INC
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Dates
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Enumeration Date | 01/30/2020
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Last Update Date | 01/30/2020
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Provider Practice Location Address
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Address Line | 1532 SAN BERNARDINO AVE STE A2
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City | POMONA
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State | CA
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Zip | 91767-3559
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Country | US
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Telephone | 909-447-2323
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Fax | 909-447-1199
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Provider Business Mailing Address
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Address Line | PO BOX 1757
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City | POMONA
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State | CA
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Zip | 91769-1757
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Country | US
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Telephone | 909-447-2323
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Fax | 909-447-1199
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Authorized Official
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Title or Position | OWNER
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Name | EMELIA ODURO JEFFREY
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Credential | FNP-BC
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Telephone | 909-447-2323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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