Provider Demographics
NPI:1740763689
Name:DURON, IDA GUADALUPE (LVN)
Entity Type:Individual
Prefix:
First Name:IDA
Middle Name:GUADALUPE
Last Name:DURON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17982 SKY PARK CIR STE J
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6482
Mailing Address - Country:US
Mailing Address - Phone:949-809-5700
Mailing Address - Fax:949-809-5779
Practice Address - Street 1:17982 SKY PARK CIR STE J
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6482
Practice Address - Country:US
Practice Address - Phone:949-809-5700
Practice Address - Fax:949-809-5779
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA199570164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse