Provider Demographics
NPI:1073724993
Name:TITO V DURAN AND JOSEFINA D DURAN
Entity Type:Organization
Organization Name:TITO V DURAN AND JOSEFINA D DURAN
Other - Org Name:DANIELS CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOSEFINA
Authorized Official - Middle Name:DABU
Authorized Official - Last Name:DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-803-7039
Mailing Address - Street 1:1117 W 164TH ST
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4802
Mailing Address - Country:US
Mailing Address - Phone:310-217-0437
Mailing Address - Fax:310-217-0642
Practice Address - Street 1:1117 W 164TH ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4802
Practice Address - Country:US
Practice Address - Phone:310-217-0437
Practice Address - Fax:310-217-0642
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TITO V DURAN AND JOSEFINA D DURAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-24
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA960000990311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC60786FOtherMEDICAL