Provider Demographics
NPI:1912107012
Name:TODERAN, DUANE (CO)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:
Last Name:TODERAN
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:3625 E THOUSAND OAKS BLVD
Mailing Address - Street 2:#138
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3626
Mailing Address - Country:US
Mailing Address - Phone:805-494-4788
Mailing Address - Fax:805-494-1697
Practice Address - Street 1:3625 E THOUSAND OAKS BLVD
Practice Address - Street 2:#138
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3626
Practice Address - Country:US
Practice Address - Phone:805-494-4788
Practice Address - Fax:805-494-1697
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA001184222Z00000X
CA00184224P00000X, 225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100637OtherSTATE OF CALIFORNIA HOME