Provider Demographics
NPI:1245855717
Name:DUARTE, GEORGE TYLER
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:TYLER
Last Name:DUARTE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21622 MARGUERITE PKWY APT 220
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-4413
Mailing Address - Country:US
Mailing Address - Phone:562-708-1627
Mailing Address - Fax:
Practice Address - Street 1:21622 MARGUERITE PKWY APT 376
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-4419
Practice Address - Country:US
Practice Address - Phone:562-708-1627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA144977106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist