Provider Demographics
NPI:1396811162
Name:DUARTE, JULIO SR (LSA)
Entity type:Individual
Prefix:MR
First Name:JULIO
Middle Name:
Last Name:DUARTE
Suffix:SR
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1062
Mailing Address - Street 2:20935 SOUTH AMBER WILLOW TRAIL
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77410-1062
Mailing Address - Country:US
Mailing Address - Phone:281-460-8771
Mailing Address - Fax:281-256-9416
Practice Address - Street 1:20935 SOUTH AMBER WILLOW TRAIL
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-6041
Practice Address - Country:US
Practice Address - Phone:281-460-8771
Practice Address - Fax:281-256-9416
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-25
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00118363AS0400X, 246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty