Provider Demographics
NPI:1740064351
Name:DURAN, JESUS GUILLERMO JR (LPHA-INTERN)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:GUILLERMO
Last Name:DURAN
Suffix:JR
Gender:M
Credentials:LPHA-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 DELA VINA AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-3974
Mailing Address - Country:US
Mailing Address - Phone:831-440-7030
Mailing Address - Fax:
Practice Address - Street 1:343 DELA VINA AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-3974
Practice Address - Country:US
Practice Address - Phone:831-440-7030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker