Provider Demographics
NPI:1720738651
Name:DURAN, ELAINE MARIE
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARIE
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 1:11650 CHERRY AVE APT 11B
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-0156
Mailing Address - Country:US
Mailing Address - Phone:909-276-8517
Mailing Address - Fax:
Practice Address - Street 1:6117 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2232
Practice Address - Country:US
Practice Address - Phone:909-276-8517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst