Provider Demographics
NPI:1598192197
Name:DURAZO, CARLOTTA A
Entity Type:Individual
Prefix:
First Name:CARLOTTA
Middle Name:A
Last Name:DURAZO
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 1:7957 CALLE COZUMEL
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-9318
Mailing Address - Country:US
Mailing Address - Phone:760-310-9036
Mailing Address - Fax:760-796-3785
Practice Address - Street 1:500 LA TERRAZA BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3875
Practice Address - Country:US
Practice Address - Phone:760-737-2050
Practice Address - Fax:760-796-3785
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS107141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical