Provider Demographics
NPI:1982644043
Name:DURALDE, THOMAS JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOSEPH
Last Name:DURALDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 W ROSECRANS AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-6609
Mailing Address - Country:US
Mailing Address - Phone:310-727-1723
Mailing Address - Fax:310-536-0495
Practice Address - Street 1:5400 W ROSECRANS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-6609
Practice Address - Country:US
Practice Address - Phone:310-727-1723
Practice Address - Fax:310-643-9707
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine