Provider Demographics
NPI:1689989386
Name:DURAN, MARISELA (RN)
Entity Type:Individual
Prefix:
First Name:MARISELA
Middle Name:
Last Name:DURAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 VALLEY RD
Mailing Address - Street 2:#8
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-4120
Mailing Address - Country:US
Mailing Address - Phone:619-434-4090
Mailing Address - Fax:
Practice Address - Street 1:5202 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-2268
Practice Address - Country:US
Practice Address - Phone:619-229-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA547664163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse