Provider Demographics
NPI:1689746372
Name:DURAN SIROF, MARCELA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARCELA
Middle Name:
Last Name:DURAN SIROF
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARCELA
Other - Middle Name:
Other - Last Name:DURAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:4406 W MAGNOLIA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505
Mailing Address - Country:US
Mailing Address - Phone:818-260-0264
Mailing Address - Fax:818-260-8743
Practice Address - Street 1:4406 W MAGNOLIA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505
Practice Address - Country:US
Practice Address - Phone:818-260-0264
Practice Address - Fax:818-260-8743
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40232122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4023201Medicare ID - Type Unspecified