Provider Demographics
NPI:1891457792
Name:DURU, MAGNUS OKECHUKWU (NP)
Entity Type:Individual
Prefix:
First Name:MAGNUS
Middle Name:OKECHUKWU
Last Name:DURU
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 PAUL DR STE A
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2047
Mailing Address - Country:US
Mailing Address - Phone:510-631-7451
Mailing Address - Fax:
Practice Address - Street 1:121 PAUL DR STE A
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2047
Practice Address - Country:US
Practice Address - Phone:415-578-4983
Practice Address - Fax:415-578-7435
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018651363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95018651OtherNP LICENSE