Provider Demographics
NPI:1891410221
Name:DUCTOC, DEANNA ANTOINETTE (MS, ATC, CEAS)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:ANTOINETTE
Last Name:DUCTOC
Suffix:
Gender:F
Credentials:MS, ATC, CEAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 MIDWICKHILL DR
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-4510
Mailing Address - Country:US
Mailing Address - Phone:626-487-6251
Mailing Address - Fax:
Practice Address - Street 1:8625 WOODMAN AVE
Practice Address - Street 2:
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331-6504
Practice Address - Country:US
Practice Address - Phone:213-200-0355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000112382081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine