Provider Demographics
NPI:1134653090
Name:DUARTE, JOSE JESUS JR
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:JESUS
Last Name:DUARTE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 W 218TH PL APT 16
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2822
Mailing Address - Country:US
Mailing Address - Phone:310-729-2336
Mailing Address - Fax:
Practice Address - Street 1:521 W 218TH PL APT 16
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-2822
Practice Address - Country:US
Practice Address - Phone:310-729-2336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator