Provider Demographics
NPI:1134245624
Name:DURAN, JOSEFINA DABU
Entity type:Individual
Prefix:MRS
First Name:JOSEFINA
Middle Name:DABU
Last Name:DURAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19213 NESTOR AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-2605
Mailing Address - Country:US
Mailing Address - Phone:424-338-6096
Mailing Address - Fax:
Practice Address - Street 1:19213 NESTOR AVE
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-2605
Practice Address - Country:US
Practice Address - Phone:424-338-6096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN163071164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550004419Medicaid
CA55G080Medicaid