Provider Demographics
NPI:1659783900
Name:DUARTE, RAYMOND
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:DUARTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3553 ATLANTIC AVE
Mailing Address - Street 2:# A
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-5606
Mailing Address - Country:US
Mailing Address - Phone:562-427-5577
Mailing Address - Fax:562-427-1807
Practice Address - Street 1:3553 ATLANTIC AVE
Practice Address - Street 2:# A
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-5606
Practice Address - Country:US
Practice Address - Phone:562-427-5577
Practice Address - Fax:562-427-1807
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA267364164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse