Provider Demographics
NPI:1164688438
Name:DURAN, TAMI KRISTINA (LPT)
Entity Type:Individual
Prefix:MS
First Name:TAMI
Middle Name:KRISTINA
Last Name:DURAN
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:MRS
Other - First Name:TAMI
Other - Middle Name:KRISTINA
Other - Last Name:CESSWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPT
Mailing Address - Street 1:1435 STANLEY AVE
Mailing Address - Street 2:APT 117
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-3984
Mailing Address - Country:US
Mailing Address - Phone:818-484-5473
Mailing Address - Fax:
Practice Address - Street 1:223 E ROWLAND ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3147
Practice Address - Country:US
Practice Address - Phone:626-332-3145
Practice Address - Fax:626-974-4164
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 30023374700000X
CAPT30023167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician
No374700000XNursing Service Related ProvidersTechnician