Provider Demographics
NPI:1780847004
Name:DUARTE, SANDRA (MA)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:DUARTE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 W 5TH ST STE 211
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-4522
Mailing Address - Country:US
Mailing Address - Phone:714-834-2486
Mailing Address - Fax:
Practice Address - Street 1:405 W 5TH ST STE 211
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4522
Practice Address - Country:US
Practice Address - Phone:714-834-2486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104541106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist