Provider Demographics
NPI:1003452129
Name:DUARTE-LAABS, GERRY ANN I
Entity Type:Individual
Prefix:
First Name:GERRY
Middle Name:ANN
Last Name:DUARTE-LAABS
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30617 BAYPORT LN
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-8976
Mailing Address - Country:US
Mailing Address - Phone:619-813-1069
Mailing Address - Fax:
Practice Address - Street 1:30617 BAYPORT LN
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-8976
Practice Address - Country:US
Practice Address - Phone:619-813-1069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-24
Last Update Date:2019-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst