Provider Demographics
NPI:1558640060
Name:DURAN-CARRASCO, ANITA M
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:M
Last Name:DURAN-CARRASCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 MORENA BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3703
Mailing Address - Country:US
Mailing Address - Phone:619-275-8000
Mailing Address - Fax:619-275-8004
Practice Address - Street 1:1675 MORENA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3703
Practice Address - Country:US
Practice Address - Phone:619-275-8000
Practice Address - Fax:619-275-8004
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator