Provider Demographics
NPI:1275635864
Name:DIMAANO, CECILIA DURBAN (MD)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:DURBAN
Last Name:DIMAANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA CECILIA
Other - Middle Name:DURBAN
Other - Last Name:DIMAANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4001 E BASELINE RD
Mailing Address - Street 2:STE 205
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2726
Mailing Address - Country:US
Mailing Address - Phone:480-962-7510
Mailing Address - Fax:480-649-0942
Practice Address - Street 1:4001 E BASELINE RD
Practice Address - Street 2:STE 205
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2726
Practice Address - Country:US
Practice Address - Phone:480-962-7510
Practice Address - Fax:480-649-0942
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13509174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist