Provider Demographics
NPI:1194865543
Name:ANTONIO DURAZO MD INC
Entity Type:Organization
Organization Name:ANTONIO DURAZO MD INC
Other - Org Name:MORINDA MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-781-8080
Mailing Address - Street 1:841 W MORTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3184
Mailing Address - Country:US
Mailing Address - Phone:559-781-8080
Mailing Address - Fax:559-781-8960
Practice Address - Street 1:841 W MORTON AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3184
Practice Address - Country:US
Practice Address - Phone:559-781-8080
Practice Address - Fax:559-781-8960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G486421Medicare PIN
CAZZZ31838ZMedicare PIN