Provider Demographics
NPI:1982115226
Name:DURAN, ROSA VIVIANA (BII)
Entity Type:Individual
Prefix:MS
First Name:ROSA
Middle Name:VIVIANA
Last Name:DURAN
Suffix:
Gender:F
Credentials:BII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 FAIR OAKS AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-2694
Mailing Address - Country:US
Mailing Address - Phone:213-607-4343
Mailing Address - Fax:626-240-0078
Practice Address - Street 1:625 FAIR OAKS AVE STE 200
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-2694
Practice Address - Country:US
Practice Address - Phone:213-607-4343
Practice Address - Fax:626-240-0078
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician