Basic Information
Provider Information | |||||||||
NPI: | 1255320438 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BURTON | ||||||||
FirstName: | ALLISON | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2350 BUHNE ST | ||||||||
Address2: | A | ||||||||
City: | EUREKA | ||||||||
State: | CA | ||||||||
PostalCode: | 955013238 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7074434593 | ||||||||
FaxNumber: | 7074436447 | ||||||||
Practice Location | |||||||||
Address1: | 2350 BUHNE ST | ||||||||
Address2: | A | ||||||||
City: | EUREKA | ||||||||
State: | CA | ||||||||
PostalCode: | 955013238 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7074434593 | ||||||||
FaxNumber: | 7074436447 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/19/2005 | ||||||||
LastUpdateDate: | 10/15/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/15/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 173000000X | A839110 | CA | N |   | Other Service Providers | Legal Medicine |   | 207Q00000X | A839110 | CA | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | A83911 | CA | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 00A839110 | 05 | CA |   | MEDICAID |